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Clinical Course of Breast Cancer Patients with Local-Regional Progression During Neoadjuvant Systemic Therapy

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

Abstract

Background

Neoadjuvant systemic therapy (NST) is standard for locally advanced breast cancer and is now frequently considered for those with early-stage and node-positive disease. We aimed to evaluate the treatment course and outcomes in patients with disease progression during NST.

Methods

Patients diagnosed with unilateral stage I–III breast cancer between 2005 and 2015 with documented local-regional progression while receiving NST, by clinical examination and/or imaging after two or more cycles of chemotherapy, were identified from a prospective database, stratified by receipt of surgery and outcomes analyzed.

Results

Of 6362 patients treated with NST during the study period, 124 (1.9%) developed disease progression. At a median live follow-up of 71 months, 23.4% were alive without disease and 70.2% had died from breast cancer. Median overall survival (OS) time for patients with progression was 26 months and median distant disease-free survival (DFS) was 14 months. Triple-negative breast cancer was associated with a higher likelihood of death (p < 0.001) and development of distant metastasis (p = 0.002). Among patients who had surgery (104, 89.3%), 40 (38.5%) developed local-regional recurrence, 67 (64.4%) developed distant metastasis, and 69 (66.3%) died from breast cancer. Median OS and median distant DFS in this subgroup was 31 and 16 months, respectively.

Conclusions

High rates of local-regional and distant failure were seen following disease progression while receiving NST. This suggests aggressive tumor biology and the need to study novel systemic therapies. Poor survival outcomes despite surgical management highlight the importance of careful patient selection when considering operative intervention after progression while receiving NST.

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Author information

Authors and Affiliations

  1. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Leisha C. Elmore MD, MPHS, Henry M. Kuerer MD, PhD, Makesha V. Miggins MD, Anthony Lucci MD, Abigail S. Caudle MD, MS, Funda Meric-Bernstam MD, Kelly K. Hunt MD & Mediget Teshome MD, MPH

  2. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Carlos H. Barcenas MD, MSc

  3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Benjamin D. Smith MD

  4. Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Funda Meric-Bernstam MD

Authors
  1. Leisha C. Elmore MD, MPHS
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  2. Henry M. Kuerer MD, PhD
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Correspondence to Mediget Teshome MD, MPH.

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Disclosures

Benjamin Smith has received prior research funding from Varian Medical Systems, and has current royalty and equity interest in Oncora Medical. Funda Meric-Bernstam is a consultant for AbbVie, Aduro BioTech Inc., Alkermes, AstraZeneca, DebioPharm, eFFECTOR Therapeutics, F. Hoffman-La Roche Ltd, Genentech Inc., IBM Watson, Infinity Pharmaceuticals, Jackson Laboratory, Kolon Life Science, OrigiMed, PACT Pharma, Parexel International, Pfizer Inc., Samsung Bioepis, Seattle Genetics Inc., Tyra Biosciences, Xencor, and Zymeworks, and is a member of the Advisory Committee for Immunomedics, Inflection Biosciences, Mersana Therapeutics, Puma Biotechnology Inc., Seattle Genetics, Silverback Therapeutics, Spectrum Pharmaceuticals, and Zentalis. She has also undertaken sponsored research for Aileron Therapeutics, Inc. AstraZeneca, Bayer Healthcare Pharmaceutical, Calithera Biosciences Inc., Curis Inc., CytomX Therapeutics Inc., Daiichi Sankyo Co. Ltd, Debiopharm International, eFFECTOR Therapeutics, Genentech Inc., Guardant Health Inc., Klus Pharma, Takeda Pharmaceutical (formerly Millennium Pharmaceutical), Novartis, Puma Biotechnology Inc., and Taiho Pharmaceutical Co., and has received honoraria from Chugai Biopharmaceuticals. Kelly Hunt is a member of the Medical Advisory Board of Armada Health and Merck & Co., and has received research funding to her institution from Cairn Surgical, Eli Lilly and Company, Lumicell, and OncoNano Medicine. Leisha C. Elmore, Henry M. Kuerer, Carlos H. Barcenas, Makesha V. Miggins, Anthony Lucci, Abigail S. Caudle, and Mediget Teshome have no conflicts of interest to declare.

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Elmore, L.C., Kuerer, H.M., Barcenas, C.H. et al. Clinical Course of Breast Cancer Patients with Local-Regional Progression During Neoadjuvant Systemic Therapy. Ann Surg Oncol 28, 5477–5485 (2021). https://doi.org/10.1245/s10434-021-10444-w

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  • DOI: https://doi.org/10.1245/s10434-021-10444-w

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