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The prevalence and predictors of adjuvant chemotherapy use among patients treated with neoadjuvant endocrine therapy

  • Epidemiology
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Abstract

Purpose

Neoadjuvant endocrine therapy (NET) facilitates clinical response and breast conservation in hormone receptor-positive (HR-positive) breast cancer. Patient selection for adjuvant chemotherapy (CT) post-NET is unclear and potentially evolving with use of genomic assays. We evaluated post-NET CT use in a national dataset.

Methods

Using the National Cancer DataBase, we identified patients with cT2-3N0-3M0 HR-positive/human epidermal growth factor receptor 2-negative breast cancer treated between 2010 and 2017 with 3–12 months of NET prior to breast surgery. CT use was evaluated in the overall population, in patients with a pathologic complete response (pCR) and in patients with ypT1-2N0 disease (approximating PEPI 0). Exploratory analysis included patients > 50 years with ypN0-1, and 21-gene recurrence score (RS) ≤ 25 (approximating TAILORx/RxPONDER populations not benefiting from CT). Multivariable logistic regression was used to identify factors associated with CT.

Results

Among 3624 eligible patients, 20.4% (740/3624) received CT. On multivariable analysis, age ≤ 50, lobular histology, grade 2, progesterone receptor negativity, ypT3, ypN + and RS ≥ 18 were associated with CT receipt. Co-morbidity, longer NET duration, ypT4, ypNx, and RS < 18 were associated with CT omission. CT was administered to 3.3% (1/30) of patients experiencing pCR and 5.5% (82/1483) with ypT1-2N0 disease. Among patients > 50 years with ypT0-3N0-1 residual disease, 13.8% (355/2569) received CT; RS was available for 24.8% (88/355) and 60% (53/88) had a score 0–25.

Conclusion

A minority of patients receive CT post-NET. This decision appears to be driven by younger age, RS and pathological nodal status. Increased consideration of these factors prior to neoadjuvant treatment choice may be warranted.

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Data availability

The data from the National Cancer Data Base, analyzed during the current study, are not publicly available. The data will be made available to researchers at the Commission on Cancer (CoC) centers, who have completed an application form and a Data Usage Agreement. Please contact NCDB_PUF@facs.org for data access requests.

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Acknowledgements

The authors would also like to thank Valerie Hope Goldstein for her assistance with editing and manuscript submission.

Funding

There was no specific funding or grant for this project. Dr. Sella is supported by the Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Israel and The American Physicians Fellowship for Medicine in Israel.

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Authors and Affiliations

  1. Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Tal Sella, Ann H. Partridge & Otto Metzger

  2. Harvard Medical School, Boston, MA, USA

    Tal Sella, Olga Kantor, Anna Weiss, Ann H. Partridge, Otto Metzger & Tari A. King

  3. Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA

    Tal Sella, Olga Kantor, Anna Weiss, Ann H. Partridge, Otto Metzger & Tari A. King

  4. Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Olga Kantor, Anna Weiss & Tari A. King

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  1. Tal Sella
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Contributions

Conceptualization: TS, OK, AW; data curation: OK; formal analysis: OK; investigation: All authors; methodology: TS, OK, OM, TAK; supervision: TAK; visualization: TS, OK, TAK; writing—original draft: TS, TAK; writing—review and editing: all authors. Previous presentation: none.

Corresponding author

Correspondence to Tari A. King.

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Competing interests

Anna Weiss: Institutional sponsored research agreement from Myriad Laboratories, Inc. Otto Metzger: Stock and other ownership interests: Invitae. Honoraria: Grupo Oncoclinicas, Merck. Consulting or advisory role: Grupo Oncoclinicas, Resilience Care, Alliance for Clinical Trials in Oncology. Speakers' Bureau: AstraZeneca. Research funding (to institution): Eisai, Abbvie, Susan G. Komen for the Cure, Roche/Genentech, Pfizer, Cascadian Therapeutics. Patents, royalties, other intellectual property (to institution): Sanofi. Travel, accommodations, expenses: Grupo Oncoclinicas. Tari A. King: Speakers Honoraria and compensated service on Scientific Advisory Board: Exact Sciences (formerly Genomic Health). Compensated service for a Global Advisory Board: Besins Healthcare. The authors Tal Sella, Olga Kantor, and Ann H. Partridge declare that they have no conflict of interest.

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Sella, T., Kantor, O., Weiss, A. et al. The prevalence and predictors of adjuvant chemotherapy use among patients treated with neoadjuvant endocrine therapy. Breast Cancer Res Treat 194, 663–672 (2022). https://doi.org/10.1007/s10549-022-06647-8

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