Kefah Mokbel, Chair of Breast Cancer Surgery at London Breast Institute and Honorary Professor of Medicine at Cardiff University School of Medicine, shared a post on LinkedIn:
“One-size-fits-all NACT in HR+/HER2− breast cancer is no longer justified
New real-world data from a cohort of 990 patients demonstrate that neoadjuvant chemotherapy (NACT) can confer a meaningful survival advantage—but only in carefully selected patients.
Key findings:
NACT vs upfront surgery was associated with improved outcomes:
Overall survival: HR 0.60 (40% reduction in mortality)
Disease-free survival: HR 0.61
However, this benefit was not uniform across all patients.
In the Luminal B subgroup:
Overall survival: HR 0.47 (53% reduction in mortality)
In high-risk Luminal B patients (defined by T3/N2 disease or Ki-67 ≥30%):
5-year overall survival: 91.5% vs 80.9%
Absolute improvement: +10.6%
In contrast, lower-risk patients derived no survival benefit:
HR 1.30
Clinical interpretation:
These findings reinforce that NACT should not be routinely applied to all HR+/HER2− patients. Its benefit appears concentrated in tumors with aggressive biology and high tumor burden, particularly Luminal B disease. A risk-adapted approach is therefore essential, prioritizing NACT in high-risk patients while avoiding overtreatment in lower-risk subgroups.
Limitations:
This is a retrospective real-world analysis, and therefore subject to selection bias and residual confounding despite adjustment. Treatment allocation was not randomized, and factors such as chemotherapy regimens, adherence, and evolving systemic therapies may influence outcomes. Additionally, subgroup analyses—particularly within Luminal B categories—may be underpowered and should be interpreted with caution. Prospective validation is needed before definitive practice changes.
Bottom line:
NACT in HR+/HER2− breast cancer should be individualized. The data support selective use in high-risk Luminal B disease rather than a universal treatment strategy.”
Title: Survival benefit of neoadjuvant chemotherapy in HR+/HER2− early breast cancer stratified by luminal B status and clinical risk: a real-world cohort study in a Chinese population
Authors: Wei Wang, Xueyan Liang, Yuchao Yang, Wenhai Zhang, Denghua Huang, Jiajun Li, Yukun Liu, Hui Ren
Read the Full Article.
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