Intern Med J 2019 Apr 16. Epub 2019 Apr 16.
Medical Oncology, Palmerston North Hospital, New Zealand.
Aims: Neoadjuvant Chemotherapy (NACT) is increasingly used for managing locally advanced and high risk non-metastatic breast cancer(NMBC). The goal of this study is to describe trends in NACT use, assess compliance to best practice recommendations and determine treatment response rates in a regional cancer treatment service.
Method: In this retrospective cross- sectional study, electronic records of patients who underwent NACT in centres covered by the Midcentral Regional Cancer Treatment Service (RCTS) in 2013 and 2017 were reviewed. Data pertaining to patient demographics, disease status, compliance to best practice recommendations, and treatment outcomes were extracted and analysed.
Results: Of a total of 502 referrals for NMBC, 34 underwent NACT with the estimated NACT rate rising from 3.85% (2013) to 9.92% (2017). Compliance to practice recommendations improved in all domains (pre-treatment tumour and axillary evaluation, marker placement, multidisciplinary discussion). Overall, NACT was well tolerated with only three patients experiencing treatment limiting toxicity. Response rates mirror published data (complete response: 29.4%, partial: 61.8%) with higher responses registered in HER2 Positive and Triple Negative subtypes. Discordance between radiological and pathological response was 28%, with imaging overestimating response in five out of seven cases. Of the 11 patients (32%) who initially underwent breast conserving surgery, six required a second surgery.
Conclusion: Neoadjuvant chemotherapy is increasingly used in the RCTS, with improving compliance to practice recommendations. These results are reassuring and can be used to help patients develop a realistic expectation towards NACT. This article is protected by copyright. All rights reserved.