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Trends in neoadjuvant chemotherapy versus surgery-first in stage I HER2-positive breast cancer patients in the National Cancer DataBase (NCDB)

  • Epidemiology
  • Published:
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Abstract

Background

Neoadjuvant chemotherapy (NAC) is the standard of care for locally advanced HER2 + breast cancer (BC). Optimal sequencing of treatment (NAC vs. surgery first) is less clear cut in stage I (T1N0) HER2 + BC, where information from surgical pathology could impact adjuvant treatment decisions. Utilizing the NCDB, we evaluated the trend of NAC use compared to upfront surgery in patients with small HER2 + BC.

Methods

We identified NCDB female patients diagnosed with T1 N0 HER2 + BC from 2010 through 2015. Prevalence ratios (PR) using multivariable robust Poisson regression models were calculated to measure the association between baseline characteristics and the receipt of NAC. Analysis of trends over time was denoted by annual percent change (APC) of NAC versus surgery upfront.

Results

Of the 14,949 that received chemotherapy and anti-HER2 therapy during the study period, overall 1281 (8.6%) received NAC and 13,668 (91.4%) received adjuvant treatment. Patients receiving NAC increased annually from 4.2% in 2010 to 17.3% in 2015, with the most rapid increase occurring between years 2013 (8.5%) and 2014 (14.2%). The greatest increase was seen in patients with cT1c tumors with an APC of 37.8% over the study period (95% CI 29.0, 47.3%, p < 0.01), although a significant trend was likewise seen in patients with cT1a (APC = 26.1%,95% CI 1.59, 56.6%), and cT1b (APC = 27.4%, 95% CI 18.0, 37.7%) tumors. Predictors of neoadjuvant therapy receipt were age younger than 50 (PR = 1.69, 95% CI 1.52, 1.89), Mountain/Pacific area (PR = 1.24, 95% CI 1.05, 1.46), and estrogen receptor negativity (ER− PR + : PR = 2.01, 95% CI 1.51, 2.68; ER− PR− : PR = 1.49, 95% CI 1.32, 1.69).

Conclusions

Neoadjuvant therapy for T1 N0 HER2 + BC increased over the study period and was mostly due increased use in clinical T1c tumors. This may be consistent with secular change in Pertuzumab treatment following FDA approval in 2013.

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Acknowledgements

The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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Authors and Affiliations

  1. Dubin Breast Center of the Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA

    Michael Zeidman, Hank Schmidt, J. Jaime Alberty-Oller, Kereeti V. Pisapati, Soojin Ahn & Elisa Port

  2. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Michael Zeidman, Hank Schmidt, J. Jaime Alberty-Oller, Kereeti V. Pisapati, Soojin Ahn, Madhu Mazumdar, Meng Ru, Erin Moshier & Elisa Port

  3. Institute for Healthcare Delivery Science at the Mount Sinai Health System, New York, NY, USA

    Madhu Mazumdar, Meng Ru & Erin Moshier

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  1. Michael Zeidman
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Correspondence to Michael Zeidman.

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This article does not contain any studies with human participants performed by any of the authors.

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A waiver of informed consent was obtained as the information on the National Cancer Database is de-identified.

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Zeidman, M., Schmidt, H., Alberty-Oller, J.J. et al. Trends in neoadjuvant chemotherapy versus surgery-first in stage I HER2-positive breast cancer patients in the National Cancer DataBase (NCDB). Breast Cancer Res Treat 187, 177–185 (2021). https://doi.org/10.1007/s10549-020-06041-2

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