Long-Term Outcomes With Neoadjuvant vs Adjuvant Chemotherapy in Early Breast Cancer

Key Points

  • Neoadjuvant chemotherapy was associated with a higher local recurrence rate in patients with early breast cancer.
  • No differences in distant recurrence or breast cancer–specific or overall mortality were observed.

A meta-analysis reported in The Lancet Oncology by the Early Breast Cancer Trialists’ Collaborative Group indicates that neoadjuvant chemotherapy is associated with a higher local recurrence risk vs the same chemotherapy given postoperatively after breast-conserving therapy.

Study Details

The meta-analysis included patient-level data from 4,756 women from 10 randomized trials in early breast cancer that were started before 2005 and compared neoadjuvant chemotherapy with the same chemotherapy given postoperatively. Patients entered the trials between 1983 and 2002. Overall, 81% of women received anthracycline-based chemotherapy.

Long-Term Outcomes

Median follow-up was 9 years, with follow-up ending in 2013. Among women randomized to receive neoadjuvant chemotherapy, 69% had a complete or partial clinical response. Breast-conserving therapy was more common among women receiving neoadjuvant chemotherapy vs those receiving adjuvant chemotherapy (65% vs 49%). Local recurrence rates at 15 years were 21.4% for neoadjuvant chemotherapy vs 15.9% for adjuvant chemotherapy (rate ratio [RR] = 1.37, P = .0001). There were no significant differences between neoadjuvant chemotherapy and adjuvant therapy for 15-year distant recurrence (38.2% vs 38.0%, RR = 1.02, P = .66), breast cancer mortality (34.4% vs 33.7%, RR = 1.06, P = .31), or all-cause mortality (40.9% vs 41.2%, RR = 1.04, P = .45).

The investigators concluded: “Tumours downsized by [neoadjuvant chemotherapy] might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received [neoadjuvant chemotherapy]. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by [neoadjuvant chemotherapy] should be considered—e.g., careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy.”

The study was funded by Cancer Research UK, British Heart Foundation, UK Medical Research Council, and UK Department of Health.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.




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