Node+ invasive lobular carcinoma: adjuvant tops neoadjuvant chemotherapy

  • Tamirisa N & al.
  • J Surg Oncol
  • 6 May 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Patients with invasive lobular carcinoma (ILC) tend to present with larger tumor size than those with invasive ductal carcinoma, and thus are more frequently recommended for neoadjuvant chemotherapy (NACT) than adjuvant chemotherapy (ACT).
  • In this large cohort, patients with node+ early-stage ILC receiving NACT had 38% worse 10-year OS than ACT recipients.

Why this matters

  • Findings, if confirmed, suggest that ACT is superior to NACT for this population.

Study design

  • Retrospective cohort of 15,573 patients with cT1-4c, cN1-3 ILC, of whom 35.6% received NACT, in the US National Cancer Data Base (2004-2013).
  • Funding: NIH.

Key results

  • NACT recipients (vs ACT recipients) had similar rates of pT3/4 disease (26.6% vs 26.2%, respectively), nodal involvement (median 3 vs 4), and number of lymph nodes examined (median 13 vs 14), but higher mastectomy rates (81.8% vs 74.5%; P<.001>
  • Only 3.4% of NACT patients developed pathologic complete response (pCR).
  • NACT recipients had worse unadjusted 10-year OS (54.4% vs 65.1% with ACT; P<.001>
  • NACT recipients had 38% worse adjusted 10-year OS (adjusted HR, 1.38; 95% CI, 1.25-1.52).

Limitations

  • Retrospective, observational design.
  • pCR not reported for ACT recipients.
  • The database does not contain information on recurrence rates or breast cancer-specific survival.

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