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Neoadjuvant chemotherapy for triple-negative and Her2 +ve breast cancer: striving for the standard of care

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Abstract

Purpose

Neoadjuvant chemotherapy (NAC) for triple-negative (TN) and Her2-positive (HER2) breast cancers is supported by international guidelines as it can decrease extent of surgery, provide prognostic information, and allow response-driven adjuvant therapies. Our goal was to describe practice patterns for patients with TN and HER2-positive breast cancer and identify the factors associated with the receipt of NAC versus surgery as initial treatment.

Methods

A retrospective population-based cohort study of adult women diagnosed with stage I–III TN or HER2-positive breast cancer (2012–2020) in Ontario was completed using linked administrative datasets. The primary outcome was NAC as first treatment. The association between NAC and patient, tumor, and practice-related factors was examined using multivariable logistic regression models.

Results

Of 14,653 patients included, 23.9% (n = 3500) underwent NAC as first treatment. Patients who underwent NAC were more likely to be younger and have larger tumors, node-positive disease, and stage 3 disease. Of patients who underwent surgery first, 8.8% were seen by a medical oncologist prior to surgery. On multivariable analysis, increasing tumor size (T2 vs T1/T0: 2.75 (2.31–3.28)) and node-positive (N1 vs N0: OR 3.54 (2.92–4.30)) disease were both associated increased odds of receiving NAC.

Conclusion

A considerable proportion of patients with TN and HER2-positive breast cancer do not receive NAC as first treatment. Of those, most were not assessed by both a surgeon and medical oncologist prior to initiating therapy. This points toward potential gaps in multidisciplinary assessment and disparities in receipt of guideline-concordant care.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to restricted access to provincial administrative datasets but may be available from the corresponding author upon reasonable request.

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Funding

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This study also received funding from Canadian Cancer Society Challenge Grant. This study was supported by the Sunnybrook AFP Association through the Innovation Fund of the Alternative Funding Plan from the Academic Health Sciences Centres of Ontario. Parts of this material are based on data and/or information compiled and provided by Cancer Care Ontario (CCO). The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

Author information

Authors and Affiliations

  1. Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Amanda Roberts, Julie Hallet, Natalie Coburn, Frances C. Wright & Nicole J. Look Hong

  2. Sunnybrook Research Institute, 2075 Bayview Ave, T2-063, Toronto, ON, M4N 3M5, Canada

    Amanda Roberts, Julie Hallet, Natalie Coburn, Frances C. Wright, Sonal Gandhi, Katarzyna Jerzak, Andrea Eisen & Nicole J. Look Hong

  3. ICES, Toronto, ON, Canada

    Lena Nguyen, Natalie Coburn & Nicole J. Look Hong

  4. Department of Medicine, Sunnybrook Health Science Centre, Toronto, ON, Canada

    Sonal Gandhi, Katarzyna Jerzak & Andrea Eisen

Authors
  1. Amanda Roberts
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Lena Nguyen. The first draft of the manuscript was written by Amanda Roberts and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Amanda Roberts.

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Roberts, A., Hallet, J., Nguyen, L. et al. Neoadjuvant chemotherapy for triple-negative and Her2 +ve breast cancer: striving for the standard of care. Breast Cancer Res Treat (2024). https://doi.org/10.1007/s10549-024-07282-1

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