Neoadjuvant therapy for breast cancer treatment: an expert panel recommendation from the Brazilian Society of Breast Surgeons 2018
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Breast cancer neoadjuvant chemotherapy (NAC) consists of the administration of cytotoxic and targeted drugs prior to breast surgery, with the objective of reducing the tumor burden to allow breast conservation. NAC also aims to improve long-term treatment outcomes such as disease-free and overall survival. To optimize clinical practice with the best available evidence for breast cancer patients in the setting of neoadjuvant treatment, the Brazilian Society of Breast Surgeons (Sociedade Brasileira de Mastologia—SBM) held a consensus conference to develop this guideline.
Twenty-two questions addressing relevant breast cancer neoadjuvant treatment were previously formulated. The voting panel comprised 25 specialists from the SBM. A consensus was established if there was 75% agreement. If there was less concordance, after discussion, the consensus was determined by a 51% concordance.
The recommendations were based on the best level of scientific evidence and the opinion from breast cancer experts, when no such research data were available.
This manuscript provides updated guidance according to the views of the SBM’s experts for the clinical practice of breast cancer surgeons. This manuscript depicts the summarized recommendations for NAC treatment.
KeywordsBreast cancer Neoadjuvant chemotherapy Recommendations Surgery Radiotherapy Treatment
The authors wish to thank the support of Brazilian Society of Breast Surgeons and the panelists who voted and discussed the questions described in this manuscript: Antonio Fernando Melo Filho, Carlos Alberto Ruiz, Cícero de Andrade Urban, Darley de Lima Ferreira Filho, Diego Chaves Rezende Morais, Eduardo Camargo Millen, Fábio Bagnoli, Fabio Postiglione Mansani, Fabrício Palermo Brenelli, Felipe Pereira Zerwes, Francisco Pimentel Cavalcante, Glauber Moreira Leitão, José Francisco Rinaldi, José Luiz Pedrini, José Ricardo Conte de Souza, Linei Urban, Luciana Naíra de Brito Lima Limongi, Marcos Nolasco H. Neves, Maria do Carmo de Abreu e Lima, Mirela Ávila Gurgel, Mônica Vieira M. Travassos Jourdan, Paula Cristina Saab, Rafael Henrique Szymanski Machado, Régis Resende Paulinelli, and Ricardo Antonio Boff. The authors also wish to thank Felipe Ades, MD, PhD for providing medical writing on behalf of Springer Healthcare. This manuscript was prepared according to the International Society for Medical Publication Professionals’ Good Publication Practice for Communicating Company-Sponsored Medical Research: the GPP3 Guidelines. Funding to support the preparation of this manuscript was provided by Produtos Roche Químicos e Farmacêuticos S.A. The authors take full responsibility for the content and conclusions stated in this manuscript. Roche did not influence the content of this publication.
Compliance with ethical standards
Conflict of interest
Fernanda Barbosa Coelho Rocha, Ana Beatriz Falcone and Gustavo Schvartsman declared that they have no conflict of interest. Antonio Carlos Buzaid is a consultant and/or plays an advisory role at Roche, BMS, MSD, Pfizer, AstraZeneca, Esai, Novartis and Blau. Juliana Martins Pimenta is a consultant and/or plays an advisory role at Roche and Novartis. Antonio Luiz Frasson is a consultant and/or plays an advisory role at Roche.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 4.EBCTCG (Early Breast Cancer Trialists’ Collaborative Group) (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. The Lancet 383:2127–2135. https://doi.org/10.1016/S0140-6736(14)60488-8 CrossRefGoogle Scholar
- 5.Regan MM, Francis PA, Pagani O et al (2016) Absolute benefit of adjuvant endocrine therapies for premenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative early breast cancer: TEXT and SOFT trials. J Clin Oncol Off J Am Soc Clin Oncol 34:2221–2231. https://doi.org/10.1200/JCO.2015.64.3171 CrossRefGoogle Scholar
- 8.Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet Lond Engl 365:1687–1717. https://doi.org/10.1016/S0140-6736(05)66544-0 CrossRefGoogle Scholar
- 9.Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2012) Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet 379:432–444. https://doi.org/10.1016/S0140-6736(11)61625-5 CrossRefGoogle Scholar
- 10.Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2018) Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol 19:27–39. https://doi.org/10.1016/S1470-2045(17)30777-5 CrossRefGoogle Scholar
- 17.Curigliano G, Burstein HJ, Winer P E, et al (2017) De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol Off J Eur Soc Med Oncol 28:1700–1712. https://doi.org/10.1093/annonc/mdx308 CrossRefGoogle Scholar
- 18.Forero A, Lyons J, Marcom PK et al (2018) NCCN Guidelines Panel Disclosures. Breast Cancer 209Google Scholar
- 19.Oxford Centre for Evidence (2009) Oxford Centre for Evidence-based Medicine—Levels of Evidence. In: CEBM. https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed 18 Apr 2018
- 20.Fisher B, Brown A, Mamounas E et al (1997) Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National surgical adjuvant breast and bowel project B-18. J Clin Oncol Off J Am Soc Clin Oncol 15:2483–2493. https://doi.org/10.1200/JCO.1918.104.22.1683 CrossRefGoogle Scholar
- 21.Mamounas EP (1997) NSABP Protocol B-27. Preoperative doxorubicin plus cyclophosphamide followed by preoperative or postoperative docetaxel. Oncol Williston Park N 11:37–40Google Scholar
- 22.Gianni L, Pienkowski T, Im Y-H et al (2012) Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol 13:25–32. https://doi.org/10.1016/S1470-2045(11)70336-9 CrossRefPubMedGoogle Scholar
- 23.Schneeweiss A, Chia S, Hickish T et al (2013) Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: a randomized phase II cardiac safety study (TRYPHAENA). Ann Oncol Off J Eur Soc Med Oncol ESMO 24:2278–2284. https://doi.org/10.1093/annonc/mdt182 CrossRefGoogle Scholar
- 24.Gianni L, Eiermann W, Semiglazov V et al (2010) Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet 375:377–384. https://doi.org/10.1016/S0140-6736(09)61964-4 CrossRefPubMedGoogle Scholar
- 34.Boughey JC, Suman VJ, Mittendorf EA et al (2013) Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 310:1455–1461. https://doi.org/10.1001/jama.2013.278932 CrossRefPubMedPubMedCentralGoogle Scholar
- 35.El Hage Chehade H, Headon H, El Tokhy O et al (2016) Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3,398 patients. Am J Surg 212:969–981. https://doi.org/10.1016/j.amjsurg.2016.07.018 CrossRefPubMedGoogle Scholar
- 37.Hylton NM, Gatsonis CA, Rosen MA et al (2016) Neoadjuvant chemotherapy for breast cancer: functional tumor volume by MR imaging predicts recurrence-free survival-results from the ACRIN 6657/CALGB 150007 I-SPY 1 TRIAL. Radiology 279:44–55. https://doi.org/10.1148/radiol.2015150013 CrossRefPubMedGoogle Scholar
- 38.Londero V, Bazzocchi M, Del Frate C et al (2004) Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy. Eur Radiol 14:1371–1379. https://doi.org/10.1007/s00330-004-2246-z CrossRefPubMedGoogle Scholar
- 44.Boughey JC, Ballman KV, Le-Petross HT et al (2016) Identification and Resection of clipped node decreases the false-negative rate of sentinel lymph node surgery in patients presenting with node-positive breast cancer (T0-T4, N1-N2) who receive neoadjuvant chemotherapy: results from ACOSOG Z1071 (alliance). Ann Surg 263:802–807. https://doi.org/10.1097/SLA.0000000000001375 CrossRefPubMedPubMedCentralGoogle Scholar
- 45.Caudle AS, Yang WT, Krishnamurthy S et al (2016) Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection. J Clin Oncol 34:1072–1078. https://doi.org/10.1200/JCO.2015.64.0094 CrossRefPubMedPubMedCentralGoogle Scholar
- 46.Schulz-Wendtland R, Dankerl P, Bani MR et al (2017) Evaluation of a marker clip system in sonographically guided core needle biopsy for breast cancer localization before and after neoadjuvant chemotherapy. Geburtshilfe Frauenheilkd 77:169–175. https://doi.org/10.1055/s-0042-124191 CrossRefPubMedPubMedCentralGoogle Scholar
- 49.Raphael J, Paramsothy T, Li N et al (2017) A single-institution experience of salvage therapy for patients with early and locally advanced breast cancer who progress during neoadjuvant chemotherapy. Breast Cancer Res Treat 163:11–19. https://doi.org/10.1007/s10549-017-4167-y CrossRefPubMedGoogle Scholar
- 51.Boughey JC, Peintinger F, Meric-Bernstam F et al (2006) Impact of preoperative versus postoperative chemotherapy on the extent and number of surgical procedures in patients treated in randomized clinical trials for breast cancer. Ann Surg 244:464–470. https://doi.org/10.1097/01.sla.0000234897.38950.5c CrossRefPubMedPubMedCentralGoogle Scholar
- 52.Bossuyt V, Provenzano E, Symmans WF et al (2015) Recommendations for standardized pathological characterization of residual disease for neoadjuvant clinical trials of breast cancer by the BIG-NABCG collaboration. Ann Oncol 26:1280–1291. https://doi.org/10.1093/annonc/mdv161 CrossRefPubMedPubMedCentralGoogle Scholar
- 54.Houssami N, Macaskill P, Marinovich ML, Morrow M (2014) The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol 21:717–730. https://doi.org/10.1245/s10434-014-3480-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 62.Huang EH, Tucker SL, Strom EA et al (2004) Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy. J Clin Oncol Off J Am Soc Clin Oncol 22:4691–4699. https://doi.org/10.1200/JCO.2004.11.129 CrossRefGoogle Scholar