Locoregional recurrence risk after neoadjuvant chemotherapy: A pooled analysis of nine prospective neoadjuvant breast cancer trials

Werutsky G, Untch M, Hanusch C, Fasching P, Blohmer JU, Seiler S, Denkert C, Tesch H, Jackisch C, Gerber B, Schneeweiss A, Link T, Krug D, Huober J, Rhiem K, Kühn T, Vladimirova V, Nekljudova V, Loibl S (2020)

Publication Type: Journal article

Publication year: 2020

Journal

European Journal of Cancer Elsevier

Book Volume: 130

Pages Range: 92-101

DOI: 10.1016/j.ejca.2020.02.015

Abstract

Aim: This pooled analysis aimed to evaluate locoregional recurrence (LRR) rates of breast cancer (BC) after neoadjuvant chemotherapy (NACT) and to identify independent LRR predictors. Methods: 10,075 women with primary BC from nine neoadjuvant trials were included. The primary outcome was the cumulative incidence rate of LRR as the first event after NACT. Distant recurrence, secondary malignancy or death were defined as competing events. For identifying LRR predictors, surgery type, pathological complete response (pCR), BC subtypes and other potential risk factors were evaluated. Results: Median followup was 67 months (range 0–215), overall LRR rate was 9.5%, 4.1% in pCR versus 9.5% in non-pCR patients. Younger age, clinically positive lymph nodes, G3 tumours, non-pCR and TNBC but not surgery type were independent LRR predictors in multivariate analysis. Among BC subtypes, 5-year cumulative LRR rates were associated with higher risk in non-pCR versus pCR patients, which was significant for HR+/HER2- (5.9% vs 3.9%; HR = 2.32 [95%CI 1.22–4.43]; p = 0.011); HR-/HER2+ (14.8% vs 3.1%; HR = 4.26 [94%CI 2.35–7.71]; p < 0.001) and TNBC (18.5% vs 4.2%; HR = 4.10 [95%CI 2.88–5.82]; p < 0.001) but not for HR+/HER2+ (8.1% vs 4.8%; HR = 1.56 [95%CI 0.85–2.85]; p = 0.150). Within non-pCR subgroup, LRR risk was higher for HR-/HER2+ and TNBC vs HR+/HER2- (HR = 2.05 [95%CI 1.54–2.73]; p < 0.001 and HR = 2.77 [95%CI 2.27–3.39]; p < 0.001, respectively). Conclusions: This pooled analysis demonstrated that young age, node-positive and G3 tumours, as well as TNBC, and non-pCR significantly increased the risk of LRR after NACT. Hence, there is a clear need to investigate better multimodality therapies in the post-neoadjuvant setting for high-risk patients.

Authors with CRIS profile

Peter Fasching Professur für Translationale Frauenheilkunde und Geburtshilfe

Involved external institutions

GBG Forschungs GmbH (German Breast Group) DE Germany (DE) Universitätsklinikum Gießen und Marburg (UKGM) DE Germany (DE) Agaplesion Markus Krankenhaus DE Germany (DE) Sana Kliniken AG DE Germany (DE) Universitätsmedizin Rostock DE Germany (DE) Universitätsklinikum Heidelberg DE Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden DE Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) DE Germany (DE) Universitätsklinikum Ulm DE Germany (DE) Universitätsklinikum Köln DE Germany (DE) Städtische Kliniken Esslingen DE Germany (DE) HELIOS Kliniken DE Germany (DE) Rotkreuzklinikum München DE Germany (DE) Charité - Universitätsmedizin Berlin DE Germany (DE)

How to cite

APA:

Werutsky, G., Untch, M., Hanusch, C., Fasching, P., Blohmer, J.U., Seiler, S.,... Loibl, S. (2020). Locoregional recurrence risk after neoadjuvant chemotherapy: A pooled analysis of nine prospective neoadjuvant breast cancer trials. European Journal of Cancer, 130, 92-101. https://doi.org/10.1016/j.ejca.2020.02.015

MLA:

Werutsky, Gustavo, et al. "Locoregional recurrence risk after neoadjuvant chemotherapy: A pooled analysis of nine prospective neoadjuvant breast cancer trials." European Journal of Cancer 130 (2020): 92-101.

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