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Sociodemographic and Clinical Predictors of Neoadjuvant Chemotherapy in cT1-T2/N0 HER2-Amplified Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The optimal treatment strategy for small node-negative human epidermal growth factor receptor 2-positive (HER2+) breast cancer remains controversial. Neoadjuvant chemotherapy may risk overtreatment, whereas surgery first fails to identify patients with residual disease in need of escalated adjuvant systemic therapy. We investigated patient characteristics associated with receipt of neoadjuvant chemotherapy.

Methods

Adult women with cT1-T2/N0, HER2+ breast cancer between 2013 and 2017 in the National Cancer Database who underwent surgery within 8 months of diagnosis were included. Patients were classified as receiving neoadjuvant chemotherapy versus a surgery-first approach. We assessed the sociodemographic and clinical predictors of neoadjuvant chemotherapy versus surgery first and associations between neoadjuvant chemotherapy and breast cancer treatments using multivariable regression models.

Results

We identified 56,784 women, of whom 12,758 (22%) received neoadjuvant chemotherapy, 29,139 (53%) received adjuvant chemotherapy, 12,907 (24%) received no chemotherapy, and 1980 were missing chemotherapy information. After adjustment, cT2 stage was the strongest predictor of neoadjuvant chemotherapy compared with surgery first. Younger age and later diagnosis year were positively associated with receipt of neoadjuvant chemotherapy. In contrast, hormone receptor positivity, Black race, rural county, and government-funded or no health insurance were inversely associated with neoadjuvant chemotherapy. In multivariable analyses, patients who received neoadjuvant chemotherapy were more likely to have a mastectomy (vs. lumpectomy) and sentinel lymph node biopsy or no nodal surgery (vs. axillary lymph node dissection). Patients who received neoadjuvant chemotherapy were more likely to receive multi-agent (vs. single-agent) chemotherapy than those who received adjuvant chemotherapy.

Conclusions

Substantial differences in the utilization of neoadjuvant chemotherapy exist in women with HER2+ breast cancer, which reflect both clinical parameters and disparities. Optimal treatment strategies should be implemented equitably across sociodemographic groups.

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Authors and Affiliations

  1. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Emilie D. Duchesneau MSPH

  2. Division of Surgical Oncology, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Selena J. An MD, Kristalyn K. Gallagher DO, David W. Ollila MD, Stephanie M. Downs-Canner MD & Philip M. Spanheimer MD

  3. Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA

    Paula D. Strassle PhD

  4. Division of Surgical Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Katherine E. Reeder-Hayes MD, Kristalyn K. Gallagher DO, David W. Ollila MD, Stephanie M. Downs-Canner MD & Philip M. Spanheimer MD

  5. Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Katherine E. Reeder-Hayes MD

Authors
  1. Emilie D. Duchesneau MSPH
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  2. Selena J. An MD
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Corresponding author

Correspondence to Philip M. Spanheimer MD.

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Disclosures

Emilie Duchesneau is supported by the Cancer Care Quality Training Program at the University of North Carolina at Chapel Hill (Grant T32CA116339); Stephanie Downs-Canner is supported by the National Institutes of Health (Grant 5K12CA120780-12; Philip Spanheimer is supported by the National Institutes of Health (Grant P50CA058223); and Paula D. Strassle is supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health. Selena J. An, Katherine Reeder-Hayes, Kristalyn K. Gallagher, and David W. Ollila have no disclosures to declare. This work was supported in part by P30 CA016086 UNC Lineberger Cancer Center Core Support Grant. The contents and views in this manuscript are those of the authors and should not be construed to represent the views of the National Institutes of Health.

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Duchesneau, E.D., An, S.J., Strassle, P.D. et al. Sociodemographic and Clinical Predictors of Neoadjuvant Chemotherapy in cT1-T2/N0 HER2-Amplified Breast Cancer. Ann Surg Oncol 29, 3051–3061 (2022). https://doi.org/10.1245/s10434-021-11260-y

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  • DOI: https://doi.org/10.1245/s10434-021-11260-y

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