%0 Journal Article
%T Neoadjuvant chemotherapy for triple-negative and Her2ā+ve breast cancer: striving for the standard of care.
%A Roberts A
%A Hallet J
%A Nguyen L
%A Coburn N
%A Wright FC
%A Gandhi S
%A Jerzak K
%A Eisen A
%A Look Hong NJ
%J Breast Cancer Res Treat
%V 206
%N 2
%D 2024 Jul 27
%M 38676808
%F 4.624
%R 10.1007/s10549-024-07282-1
%X OBJECTIVE: Neoadjuvant chemotherapy (NAC) for triple-negative (TN) and Her2-positive (HER2) breast cancers is supported by international guidelines as it can decrease extent of surgery, provide prognostic information, and allow response-driven adjuvant therapies. Our goal was to describe practice patterns for patients with TN and HER2-positive breast cancer and identify the factors associated with the receipt of NAC versus surgery as initial treatment.
METHODS: A retrospective population-based cohort study of adult women diagnosed with stage I-III TN or HER2-positive breast cancer (2012-2020) in Ontario was completed using linked administrative datasets. The primary outcome was NAC as first treatment. The association between NAC and patient, tumor, and practice-related factors was examined using multivariable logistic regression models.
RESULTS: Of 14,653 patients included, 23.9% (nā=ā3500) underwent NAC as first treatment. Patients who underwent NAC were more likely to be younger and have larger tumors, node-positive disease, and stage 3 disease. Of patients who underwent surgery first, 8.8% were seen by a medical oncologist prior to surgery. On multivariable analysis, increasing tumor size (T2 vs T1/T0: 2.75 (2.31-3.28)) and node-positive (N1 vs N0: OR 3.54 (2.92-4.30)) disease were both associated increased odds of receiving NAC.
CONCLUSIONS: A considerable proportion of patients with TN and HER2-positive breast cancer do not receive NAC as first treatment. Of those, most were not assessed by both a surgeon and medical oncologist prior to initiating therapy. This points toward potential gaps in multidisciplinary assessment and disparities in receipt of guideline-concordant care.