Sergio Cifuentes Canaval: How NACT compares to adjuvant chemotherapy for patients with HR+/HER2− breast cancer
Sergio Cifuentes Canaval, Cancer Research Project Manager at CENEIT Mexico, shared on LinkedIn about recent paper by Servah Hosseini-Mellner et al., commenting:
“Impact of Neoadjuvant vs. Adjuvant Chemotherapy on Prognosis in Patients with HR+/HER2− Breast Cancer
Real-World Insights from Sweden
Some fascinating findings from a recent Swedish real-world study that looked at how neoadjuvant chemotherapy (NACT) compares to adjuvant chemotherapy for patients with HR+/HER2− breast cancer.
Here’s a summary of the study and what it means for our daily practice:
Study Background:
This study aimed to understand the impact of NACT versus adjuvant chemotherapy on prognosis among patients with HR+/HER2− breast cancer, utilizing data from the Swedish National Quality breast cancer register. The study included patients diagnosed between 2008 and 2019, applying propensity score matching to ensure a fair comparison.
Key Insigths:
- Total of 14,459 patients were analyzed, with 2,086 receiving NACT.
- Post-matching, 1,539 patients in each group were included in the final analysis.
- Outcomes measured: Distant-Disease Free Survival (DDFS), Breast-Cancer Specific Survival (BCSS), and Overall Survival (OS).
- No significant differences in survival outcomes between NACT and adjuvant chemotherapy:
- DDFS: HR 1.20 (95% CI: 0.80-1.79)
- BCSS: HR 1.16 (95% CI: 0.54-2.49)
- OS: HR 1.14 (95% CI: 0.64-2.05)
- Similar results were seen in high-risk patients eligible for abemaciclib as adjuvant therapy.
- Subgroup analyses for patients suitable for surgical de-escalation showed comparable outcomes.
Personal Reflections
I find these results incredibly informative. They suggest that NACT is just as effective as adjuvant chemotherapy for HR+/HER2− breast cancer, offering flexibility in treatment decisions. This means we can confidently consider NACT for patients, particularly those where reducing the extent of surgery is a priority. But in context of LMIC, we have to take this info very carefully.
Clinical Applicability
These findings emphasize the value of personalized treatment plans. Until we have more definitive evidence favoring one approach over the other, the choice between NACT and adjuvant chemotherapy can be tailored to meet the unique needs of our patients, ensuring we provide the best possible care.”
Journal: Science Direct
Author: Servah Hosseini-Mellner, Asa Wickberg, Andreas Karakatsanis, Antonis Valachis
