Treatment times in breast cancer patients receiving neoadjuvant vs adjuvant chemotherapy: Is efficiency a benefit of preoperative chemotherapy?

Melchior, Nicole M.; Sachs, Darren B.; Gauvin, Gabrielle; Chang, Cecilia; Wang, Chihsiung E.; Sigurdson, Elin R.; Daly, J.M.; Aggon, Allison A.; Hayes, S.B.; Obeid, Elias; Bleicher, Richard J.

doi:10.1002/cam4.2912

Cited by 14 publications

(10 citation statements)

References 27 publications

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“…Since the 1970s, NAC has been an inseparable part of breast cancer treatment, and the treatment of approximately 18% of patients diagnosed with breast cancer starts with NAC [20,21].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of breast imaging with ultrasonography, magnetic resonance and mammography in the assessment of residual tumor after neoadjuvant chemotherapy in breast cancer patients

Yıldırım¹,

Uçar²,

YETİŞ³

et al. 2022

Journal of Surgery and Medicine

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Background/Aim: Following the administration of neoadjuvant chemotherapy (NAC), a complete pathological response (pCR) is seen at rates of up to 50-70% in breast cancer patients, especially in triplenegative (TNBC) and HER-2 enriched subgroups and related to increased pCR rates, studies to predict the pathological response with preoperative evaluation are ongoing. The aim of this study was to investigate the correlation of preoperative imaging in breast cancer patients receiving NAC with the pathological response. Methods: The study, organized as a retrospective cohort study, included 129 breast patients who underwent surgery after NAC between April 2014 and February 2020. The demographic data of the patients, the clinical and radiological findings before and after NAC, operation findings, and the histopathological evaluation results were collected retrospectively from the patient files. The radiological images of the patients were examined by separating into groups of patients with ultrasonography (US), magnetic resonance imaging (MRI), US+MRI, and mammography (MG)+US. The NAC response on preoperative breast US and MG was evaluated according to the RECIST-1.1 system, and the NAC response on MRI with the Goorts et al grading system. In the histopathological examination of operation material, the Miller Payne grading system for breast tissue was used in the determination of NAC response. Results:The mean age of the patients in the study was 49.17 (11.00) years. The vast majority of the patients (87.6%) were diagnosed with invasive ductal cancer, with 27.13% in luminal A, 35.65% in luminal B, 31.0% in HER-2 enriched, and 6.2% in TNBC subgroups. A statistically significant correlation was determined between the pathological response and the US+MRI, MRI, and US+MG groups, with agreement at a moderate level (Kappa: 0.653, P<0.001; Kappa: 0.443, P<0.001; Kappa: 0.481, P=0.005, respectively). Within all the groups, the group with the highest sensitivity and accuracy were seen to be the patients evaluated with US+MRI (66.67%, 90.91%, respectively). Conclusion:The results of this study demonstrated that there is a correlation between the pathological response and US+MRI, MRI, and US+MG evaluation after NAC. The US+MRI group was found to have the highest sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. When possible, the use of these two imaging methods together in the preoperative evaluation of patients is a successful method in the prediction of pathological response.

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“…Since the 1970s, NAC has been an inseparable part of breast cancer treatment, and the treatment of approximately 18% of patients diagnosed with breast cancer starts with NAC [20,21].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of breast imaging with ultrasonography, magnetic resonance and mammography in the assessment of residual tumor after neoadjuvant chemotherapy in breast cancer patients

Yıldırım¹,

Uçar²,

YETİŞ³

et al. 2022

Journal of Surgery and Medicine

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“… 13 , 19 Women who received neoadjuvant chemotherapy were excluded, as longer biopsy-to-surgery intervals would be clinically appropriate. 10 , 20 Patients with claims indicating distant metastatic disease were excluded. Lastly, patients were excluded who had missing ZIP codes for residence or surgery facility or if they did not have an identifiable surgeon.…”

Section: Methodsmentioning

confidence: 99%

Rural-Urban Differences in Breast Cancer Surgical Delays in Medicare Beneficiaries

et al. 2022

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Background Delays between breast cancer diagnosis and surgery are associated with worsened survival. Delays are more common in urban-residing patients, although factors specific to surgical delays among rural and urban patients are not well understood. Methods We used a 100% sample of fee-for-service Medicare claims during 2007–2014 to identify 238,491 women diagnosed with early-stage breast cancer undergoing initial surgery and assessed whether they experienced biopsy-to-surgery intervals > 90 days. We employed multilevel regression to identify associations between delays and patient, regional, and surgeon characteristics, both in combined analyses and stratified by rurality of patient residence. Results Delays were more prevalent among urban patients (2.5%) than rural patients (1.9%). Rural patients with medium- or high-volume surgeons had lower odds of delay than patients with low-volume surgeons (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.58–0.88; OR = 0.74, 95% CI = 0.61–0.90). Rural patients whose surgeon operated at ≥ 3 hospitals were more likely to experience delays (OR = 1.29, 95% CI = 1.01–1.64, Ref: 1 hospital). Patient driving times ≥ 1 h were associated with delays among urban patients only. Age, black race, Hispanic ethnicity, multimorbidity, and academic/specialty hospital status were associated with delays. Conclusions Sociodemographic, geographic, surgeon, and facility factors have distinct associations with > 90-day delays to initial breast cancer surgery. Interventions to improve timeliness of breast cancer surgery may have disparate impacts on vulnerable populations by rural-urban status.

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“…The main objective of immunotherapy is to recognize and eradicate tumors by restoring the immune capacity of the host. Spontaneous remission occasionally observed in malignant melanoma and renal cell carcinoma, even when the disease is quite advanced, offers hope that this goal is achievable [8]. The humanized monoclonal antibody (MoAb) trastuzumab (Herceptin ® ) recognizes the HER-2 receptor.…”

Section: Her-2 Targeting Therapeutic Antibodiesmentioning

confidence: 99%

“…However, the use of anthracyclines and taxanes does not improve the prognostic disease, so therapy remains a major challenge. Increased improvements in the use of specific biomarkers (i.e., targeted RNAseq assay to measure both phenotype and genotype of HER-2+, ER+, PR+ related transcription, whether it is mutated or not) have resulted in significant results [8]. Moreover, multiple radiotherapy strategies are used to treat women at different tumor stages.…”

Section: Introductionmentioning

confidence: 99%

Overview of New Treatments with Immunotherapy for Breast Cancer and a Proposal of a Combination Therapy

et al. 2020

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According to data from the U.S. National Cancer Institute, cancer is one of the leading causes of death worldwide with approximately 14 million new cases and 8.2 million cancer-related deaths in 2018. More than 60% of the new annual cases in the world occur in Africa, Asia, Central America, and South America, with 70% of cancer deaths in these regions. Breast cancer is the most common cancer in women, with 266,120 new cases in American women and an estimated 40,920 deaths for 2018. Approximately one in six women diagnosed with breast cancer will die in the coming years. Recently, novel therapeutic strategies have been implemented in the fight against breast cancer, including molecules able to block signaling pathways, an inhibitor of poly [ADP-ribose] polymerase (PARP), growth receptor blocker antibodies, or those that reactivate the immune system by inhibiting the activities of inhibitory receptors like cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed death protein 1 (PD-1). However, novel targets include reactivating the Th1 immune response, changing tumor microenvironment, and co-activation of other components of the immune response such as natural killer cells and CD8+ T cells among others. In this article, we review advances in the treatment of breast cancer focused essentially on immunomodulatory drugs in targeted cancer therapy. Based on this knowledge, we formulate a proposal for the implementation of combined therapy using an extracorporeal immune response reactivation model and cytokines plus modulating antibodies for co-activation of the Th1- and natural killer cell (NK)-dependent immune response, either in situ or through autologous cell therapy. The implementation of “combination immunotherapy” is new hope in breast cancer treatment. Therefore, we consider the coordinated activation of each cell of the immune response that would probably produce better outcomes. Although more research is required, the results recently achieved by combination therapy suggest that for most, if not all, cancer patients, this tailored therapy may become a realistic approach in the near future.

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Treatment times in breast cancer patients receiving neoadjuvant vs adjuvant chemotherapy: Is efficiency a benefit of preoperative chemotherapy?

Cited by 14 publications

References 27 publications

Diagnostic performance of breast imaging with ultrasonography, magnetic resonance and mammography in the assessment of residual tumor after neoadjuvant chemotherapy in breast cancer patients

Diagnostic performance of breast imaging with ultrasonography, magnetic resonance and mammography in the assessment of residual tumor after neoadjuvant chemotherapy in breast cancer patients

Rural-Urban Differences in Breast Cancer Surgical Delays in Medicare Beneficiaries

Overview of New Treatments with Immunotherapy for Breast Cancer and a Proposal of a Combination Therapy

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