Neoadjuvant Endocrine Therapy Versus Neoadjuvant Chemotherapy in Node-Positive Invasive Lobular Carcinoma
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Neoadjuvant chemotherapy (NACT) is often recommended for patients with node-positive invasive lobular carcinoma (ILC) despite unclear benefit in this largely hormone receptor-positive (HR+) group. We sought to compare overall survival (OS) between patients with node-positive ILC who received neoadjuvant endocrine therapy (NET) and those who received NACT.
Women with cT1–4c, cN1–3 HR+ ILC in the National Cancer Data Base (2004–2014) who underwent surgery following neoadjuvant therapy were identified. Kaplan–Meier curves and Cox proportional hazards modeling were used to estimate unadjusted and adjusted overall survival (OS), respectively.
Of the 5942 patients in the cohort, 855 received NET and 5087 received NACT. NET recipients were older (70 vs. 54 years) and had more comorbidities (Charlson–Deyo score ≥ 1: 21.1% vs. 11.5%), lower cT classification (cT3–4: 44.2% vs. 51.0%), lower rates of mastectomy (72.5% vs. 82.2%), lower rates of pathologic complete response (0% vs. 2.5%), and lower rates of postlumpectomy (73.2% vs. 91.0%) and postmastectomy (60.0% vs. 80.8%) radiation versus NACT recipients (all p < 0.001). NACT recipients had higher unadjusted 10-year OS versus NET recipients (57.9% vs. 36.0%), but after adjustment, there was no significant difference in OS between the two groups (p = 0.10).
Patients with node-positive ILC who received NET presented with smaller tumors, older age, and greater burden of comorbidities versus NACT recipients but had similar adjusted OS. While there is evidence from clinical trials supporting efficacy of NET in HR+ breast cancer, our findings suggest the need for further, histology-specific investigation regarding the optimal inclusion and sequence of endocrine therapy and chemotherapy in ILC.
Portions of this manuscript were presented as part of a podium presentation at the 2019 Annual Meeting of the American Society of Breast Surgeons (ASBrS) on May 4, 2019. The National Cancer Data Base (NCDB) is a joint project of the American Cancer Society and the Commission on Cancer (CoC) of the American College of Surgeons. Established in 1989, the NCDB is a nationwide, facility-based, comprehensive clinical surveillance resource oncology dataset that currently captures ~ 70% of all newly diagnosed malignancies in the USA annually. The data used in this study are derived from a deidentified NCDB Participant User File and have not been verified by the CoC or the American Cancer Society. The American College of Surgeons has established a data use agreement with each of its CoC-accredited hospitals; these overhead groups are not responsible for the analytic or statistical methodology employed or the conclusions drawn by the authors.
Dr. R. Greenup is supported by the National Institutes of Health (NIH) Office of Women’s Research Building Interdisciplinary Research Careers in Women’s Health Award Number K12HD043446 (PI: Andrews). Dr. O. Fayanju is supported by the National Center for Advancing Translational Sciences of the NIH under award no. 1KL2TR002554 (PI: Svetkey). This work is also supported by the Duke Cancer Institute through NIH grant P30CA014236 (PI: Kastan). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Thornton, Williamson, Westbrook, Greenup, Plichta, Rosenberger, Gupta, Hyslop, Hwang and Fayanju has nothing to disclose.
This article does not contain any studies with human participants or animals performed by any of the authors. The study used deidentified information and was given exempt status by our Institutional Review Board (IRB).
- 7.Fayanju OM, Ren Y, Thomas SM, et al. The clinical significance of breast-only and node-only pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT): a review of 20,000 breast cancer patients in the National Cancer Data Base (NCDB). Ann Surg. 2018;268(4):591–601.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Ellis MJ, Suman VJ, Hoog J, et al. Randomized phase II neoadjuvant comparison between letrozole, anastrozole, and exemestane for postmenopausal women with estrogen receptor-rich stage 2 to 3 breast cancer: clinical and biomarker outcomes and predictive value of the baseline PAM50-based intrinsic subtype–ACOSOG Z1031. J Clin Oncol. 2011;29(17):2342–9.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Vriens IJH, Keymeulen K, Lobbes MBI, et al. Breast magnetic resonance imaging use in patients undergoing neoadjuvant chemotherapy is associated with less mastectomies in large ductal cancers but not in lobular cancers. Eur J Cancer (Oxford, England: 1990). 2017;81:74–80.Google Scholar
- 21.Silverstein MJ, Lewinsky BS, Waisman JR, et al. Infiltrating lobular carcinoma. Is it different from infiltrating duct carcinoma? Cancer. 1994;73(6):1673–7.Google Scholar
- 23.Tamirisa NP, Vernia H, Thomas SM, et al. The impact of chemotherapy sequence on survival in node-positive invasive lobular carcinoma. J Surg Oncol. 2019 May 6. [Epub ahead of print].Google Scholar
- 33.Cardoso F, van’t Veer LJ, Bogaerts J, et al. 70-Gene signature as an aid to treatment decisions in early-stage breast cancer. N Engl J Med. 2016;375(8):717–29.Google Scholar