Stage II-III BC: NACT tied to poorer DRFS vs ACT in black women

  • Pastoriza JM & al.
  • Clin Exp Metastasis
  • 22 Aug 2018

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

  • Treatment with neoadjuvant chemotherapy (NACT) is associated with poorer distant recurrence-free survival (DRFS) than treatment with adjuvant chemotherapy (ACT) in black, but not white, women with stage II-III breast cancer (BC).

Why this matters

  • Results counter widespread practice of giving black women NACT over ACT because NACT is thought to decrease tumor burden and improve surgical outcome.
  • A larger observational study is needed.

Study design

  • Single-center retrospective cohort of 807 patients with stage II-III BC (65% black; 35% white).
  • Cohort was evaluated for association among race, DRFS, and type of chemotherapy (NACT vs ACT).
  • Funding: NIH; Albert Einstein College of Medicine.

Key results

  • Across the entire cohort, worse DRFS was associated with stage III disease (P<.0001 and age years not black race use of nact triple-negative disease estrogen receptor-negative status>
  • Stratifying by black race, NACT was associated with worse DRFS than ACT (HR, 2.7; P<.0001>
  • Stratifying by white race, NACT was not associated with worse DRFS than ACT (HR, 1.29; P=.36).

Limitations

  • Retrospective, observational design.
  • Single-center study.
  • Limited data on confounders.

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