The landscape of systemic regimens used routinely in the neoadjuvant setting in the UK
Published Date: 01st May 2020
Publication Authors: Whitehead IJ
Introduction
Neoadjuvant systemic therapy (NST) for breast cancer has potential advantages over adjuvant treatments in selected patient groups. Previous studies identified significant variation in NST utilisation across the UK and a lack of data on routine treatment regimens and real-world outcomes.
Aims/Objectives
The NeST prospective multi-centre cohort study aimed to investigate use and outcomes of NST in UK breast cancer centres.
Method(s)
Women undergoing NST as primary breast cancer treatment from 1/12/17 to 30/11/18 at 37 UK centres were included. Patient characteristics, tumour pathology, stage, systemic and surgical treatments, and clinical and pathological outcomes were collected.
Result(s)
A total of 1053 NST patients were identified. 926 patients received neoadjuvant chemotherapy (NAC); median age was 51 years (range 22-86 years). 9.5% of patients participated in a clinical trial. Tumour pathology was HER2+ve in 47%, ER/PR/HER2-ve in 32% and ER+ve/HER2-ve in 21%. Over 20 different chemotherapy regimens were reported. 84% of HER2+ve patients received pertuzumab/ trastuzumab dual antibody therapy, 15% trastuzumab single antibody therapy, and 2% received no anti-HER2 agent; 79% of HER2+ve patients received anthracycline chemotherapy. 92% of triple negative patients received anthracycline/taxane combinations and 30% received a platinum chemotherapy agent. 89% of ER+ve/ HER2-ve patients received anthracycline/taxane combinations. Of 756 evaluable cases, complete pathological responses (pCR: ypT0ypN0) occurred in 36% of HER2+ve tumours, 37% of triple negative tumours and 8% of ER+ve/HER2-ve patients. 127 patients received neoadjuvant endocrine therapy (NET); median age was 75 years (range 42-91). 8.8% of patients were enrolled in a clinical trial. 95% of tumours were ER+ve/HER2-ve and 5% were ER+ve/ HER2+ve. Treatment duration was <=3, 3-<= 6 and >6 months in 17%, 33% and 50% respectively. Of 65 evaluable cases, pCR occurred in 2%, with 67% partial responses; 19% had no response.
Conclusion(s)
A variety of different NAC regimens are currently prescribed in the UK. Dual antibody therapy is widely used for HER2+ve patients and almost one-third of triple negative patients now receive platinum chemotherapy. pCR rates in ER+ve/HER2-ve patients are low and the benefits of NAC in these patients should be considered carefully. NET accounts for a low proportion of UK NST and is primarily used in older patients.
Copson, ER; Whitehead, IJ et al. (2020). The landscape of systemic regimens used routinely in the neoadjuvant setting in the UK: The NEST national prospective multi-centre cohort study. Breast Cancer Research and Treatment. 180 (Issue 2), 561-562.