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From clinical trials to clinical practice: outcome of NSABP-B27 neoadjuvant chemotherapy regimen for high-risk early-stage breast cancer

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Abstract

Purpose

Majority of Jordanian breast cancer patients present at a relatively young age and with locally advanced disease highlight the importance of neoadjuvant chemotherapy. This study evaluated the efficacy and safety of NSABP-B27 regimen in high-risk patients in daily clinical practice.

Methods

Patients’ medical records and hospital database were searched for all consecutive patients treated at our institution for breast cancer using neoadjuvant NSABP-B27 chemotherapy regimen. Chemotherapy was given at standard doses and schedule as originally reported in the NSABP-B27.

Results

346 female patients (median age 51 years) were treated using this regimen. Majority had high-risk features including larger tumor size (>4 cm in 68.5%), positive axillary lymph nodes (78.3%), and Grade III disease (47.4%). While most patients tolerated and completed planned chemotherapy, 41 (11.8%) patients failed to complete all four cycles of docetaxel. Following neoadjuvant chemotherapy, complete pathological response (pCR) was achieved in 84 (25.0%) evaluable patients; pCR was higher in hormone receptor-negative disease (40.0 vs. 22.1%, p = 0.002), in patient with tumor size ≤4 cm (28.3 vs. 23.5%, p = 0.024) and in patients with node-negative disease (41.2 vs. 20.7%, p = 0.002). Age (<50 vs. ≥50) had no effect, with pCR of 24.2 and 26.4%, respectively (p = 0.607). Breast-conserving surgery was performed in 85 (24.6%).

Conclusions

NSABP-B27 is an effective neoadjuvant regimen. Despite including higher risk patients, pCR is similar to the original NSABP-B27 and many other anthracycline–taxane-based regimens. Tumor size, LN status, hormone receptors status, but not age, were significant factors in achieving pCR.

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References

  1. Jordan Cancer Registry (2013) Cancer incidence in Jordan. Ministry of Health, Amman-Jordan

    Google Scholar 

  2. Abdel-Razeq H, Attiga F, Mansour A (2015) Cancer care in Jordan. Hematol Oncol Stem Cell Ther. 8(2):64–70

    Article  Google Scholar 

  3. Mieog JS, van der Hage JA, van de Velde CJ (2007) Preoperative chemotherapy for women with operable breast cancer. Cochrane Database Syst Rev. doi:10.1002/14651858.CD005002.pub2

    Article  PubMed  Google Scholar 

  4. Chen AM, Meric-Bernstam F, Hunt KK et al (2004) Breast conservation after neoadjuvant chemotherapy: the MD Anderson cancer center experience. J Clin Oncol 22:2303–2312

    Article  Google Scholar 

  5. Killelea BK, Yang VQ, Mougalian S et al (2015) Neoadjuvant chemotherapy for breast cancer increases the rate of breast conservation: results from the National Cancer Database. J Am Coll Surg 220:1063–1069

    Article  Google Scholar 

  6. Beriwal S, Schwartz GF, Komarnicky L, Garcia-Young JA (2002) Breast-conserving therapy after neoadjuvant chemotherapy: long-term results. Breast J 12:159–164

    Article  Google Scholar 

  7. Fisher B, Brown A, Mamounas E et al (1997) Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 15:2483–2493

    Article  CAS  Google Scholar 

  8. van der Hage JA, van de Velde CJ, Julien JP et al (2001) Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for research and Treatment of Cancer Trial 10902. J Clin Oncol 19:4224–4237

    Article  Google Scholar 

  9. Kaufmann M, von Minckwitz G, Mamounas EP et al (2012) Recommendations from an international consensus conference on the current status and future of neoadjuvant systemic therapy in primary breast cancer. Ann Surg Oncol 19:1508–1516

    Article  Google Scholar 

  10. Gampenrieder SP, Rinnerthaler G, Greil R (2013) Neoadjuvant chemotherapy and targeted therapy in breast cancer: past, present, and future. J Oncol 2013:732047

    Article  Google Scholar 

  11. Bear HD, Anderson S, Brown A et al (2003) The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 21:4165–4174

    Article  CAS  Google Scholar 

  12. Bear HD, Anderson S, Smith RE et al (2006) Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 24:2019–2027

    Article  CAS  Google Scholar 

  13. Smith IC, Heys SD, Hutcheon AW et al (2002) Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel. J Clin Oncol 20:1456–1466

    Article  CAS  Google Scholar 

  14. Cuppone F, Bria E, Carlini P et al (2008) Taxanes as primary chemotherapy for early breast cancer: meta-analysis of randomized trials. Cancer 113:238–246

    Article  CAS  Google Scholar 

  15. Evans TR, Yellowlees A, Foster E et al (2005) Phase III randomized trial of doxorubicin and docetaxel versus doxorubicin and cyclophosphamide as primary medical therapy in women with breast cancer: an anglo-celtic cooperative oncology group study. J Clin Oncol 23:2988–2995

    Article  CAS  Google Scholar 

  16. Diéras V, Fumoleau P, Romieu G et al (2004) Randomized parallel study of doxorubicin plus paclitaxel and doxorubicin plus cyclophosphamide as neoadjuvant treatment of patients with breast cancer. J Clin Oncol 22:4958–4965

    Article  Google Scholar 

  17. Goss PE, Ingle JN, Martino S et al (2005) Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17. J Natl Cancer Inst 97:1262–1271

    Article  CAS  Google Scholar 

  18. Cortazar P, Zhang L, Untch M et al (2014) Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet 384:164–172

    Article  Google Scholar 

  19. von Minckwitz G, Untch M, Blohmer JU et al (2012) Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol 30:1796–1804

    Article  Google Scholar 

  20. Esserman LJ, Berry DA, DeMichele A et al (2012) Pathologic complete response predicts recurrence-free survival more effectively by cancer subset: results from the I-SPY 1 TRIAL. J Clin Oncol 30:3242–3249

    Article  Google Scholar 

  21. Rastogi P, Anderson SJ, Bear HD et al (2008) Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol 26:778–785

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Al-Jubeiha, P.O. Box 1269, Amman, 11941, Jordan

    Hikmat Abdel-Razeq, Lina Marei, Salwa S. Saadeh, Hazem Abdulelah, Mahmoud Abu-Nasser, Mourad Salam, Walid Daana & Basel Al-Haj Ali

  2. Center of Research Shared Resources, King Hussein Cancer Center, Amman, Jordan

    Ayat Taqash

Authors
  1. Hikmat Abdel-Razeq
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  2. Lina Marei
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  3. Salwa S. Saadeh
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  4. Hazem Abdulelah
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  5. Mahmoud Abu-Nasser
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  6. Mourad Salam
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  7. Walid Daana
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  8. Basel Al-Haj Ali
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  9. Ayat Taqash
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Correspondence to Hikmat Abdel-Razeq.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Abdel-Razeq, H., Marei, L., Saadeh, S.S. et al. From clinical trials to clinical practice: outcome of NSABP-B27 neoadjuvant chemotherapy regimen for high-risk early-stage breast cancer. Breast Cancer Res Treat 165, 771–777 (2017). https://doi.org/10.1007/s10549-017-4359-5

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  • DOI: https://doi.org/10.1007/s10549-017-4359-5

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