The timing of systemic therapy--chemotherapy or endocrine therapy--for breast cancer does not appear to affect survival or disease progression. However, women who receive systemic therapy and radiation therapy without surgery may be more likely to experience a recurrence of their cancer compared with women treated with chemotherapy later, according to a new study in the February 2 issue of the Journal of the National Cancer Institute.
Neoadjuvant--also called preoperative or primary--systemic therapy for breast cancer may result in local tumor regression or even in a complete tumor response and may lead to a more limited extent of surgery--from radical mastectomy to some type of breast-conserving surgery--without risking patient survival. For these reasons, interest in the use of neoadjuvant therapy has been increasing.
To investigate how the timing of systemic therapy affects breast cancer outcomes, John P.A. Ioannidis, M.D., of the University of Ioannina School of Medicine in Greece, and colleagues performed a meta-analysis of nine randomized trials that had included nearly 4,000 breast cancer patients. The patients had been treated with systemic therapy either before or after surgery and/or radiation therapy.
There was no difference between neoadjuvant and adjuvant systemic therapy in terms of death, disease progression, or distant disease recurrence. However, neoadjuvant therapy was associated with a 22% increased risk of loco-regional disease recurrence compared with adjuvant therapy. This risk was higher (53%) when radiation therapy was used without surgery.
"[T]his meta-analysis demonstrates the equivalence of neoadjuvant and adjuvant treatments for breast cancer in terms of survival, disease progression, and distant recurrence and shows that an increased risk of loco-regional disease recurrence is associated with neoadjuvant treatment, especially when primary systemic treatment is not accompanied by any surgical intervention," the authors write. "Consequently, we recommend avoiding the use of radiotherapy without any surgical treatment, even in the presence of an apparently good clinical response to neoadjuvant chemotherapy."
In an editorial, Nancy E. Davidson, M.D., of the Johns Hopkins Kimmel Cancer Center in Baltimore, and Monica Morrow, M.D., of the Fox Chase Cancer Center in Philadelphia, note that surgery will remain an essential part of early breast cancer management until patients with a complete pathologic response to neoadjuvant therapy can be reliably identified. The early identification of patients who will and will not respond to systemic chemotherapy should allow those who respond to avoid toxic therapy and those who do not respond to receive more effective therapy sooner, the authors write.
Source: Eurekalert & others
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