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. 2016 Dec;160(3):491-499.
doi: 10.1007/s10549-016-4016-4. Epub 2016 Oct 15.

Changes in chemotherapy usage and outcome of early breast cancer patients in the last decade

A Hennigs  1 , F Riedel  1 , F Marmé  1   2 , P Sinn  3 , K Lindel  4 , A Gondos  5 , K Smetanay  1 , M Golatta  1 , C Sohn  1 , F Schuetz  1 , J Heil  1 , A Schneeweiss  6   7
Affiliations

Changes in chemotherapy usage and outcome of early breast cancer patients in the last decade

A Hennigs et al. Breast Cancer Res Treat. 2016 Dec.

Abstract

Background: During the last decade, neoadjuvant chemotherapy (NACT) of early breast cancer (EBC) evolved from a therapy intended to enable operability to a standard treatment option aiming for increasing cure rates equivalent to adjuvant chemotherapy (ACT). In parallel, improvements in the quality control of breast cancer care have been established in specialized breast care units.

Patients and methods: This study analyzed chemotherapy usage in patients with EBC treated at the Heidelberg University Breast Unit between January 2003 and December 2014.

Results: Overall, 5703 patients were included in the analysis of whom 2222 (39 %) received chemotherapy, 817 (37 %) as NACT, and 1405 (63 %) as ACT. The chemotherapy usage declined from 48 % in 2003 to 34 % in 2014 of the cohort. Further, the proportion of NACT raised from 42 to 65 % irrespective of tumor subtype. In addition, frequency of pathologic complete response (pCR) defined as no tumor residues in breast and axilla (ypT0 ypN0) at surgery following NACT increased from 12 % in 2003 to 35 % in 2014. The greatest effect was observed in HER2+ breast cancer with an increase in patients achieving pCR from 24 to 68 %.

Conclusions: The results mirror the refined indication for chemotherapy in EBC and its preferred usage as NACT in Germany. The increase in pCR rate over time suggests improvement in outcome accomplished by a multidisciplinary decision-making process and stringent measures for quality control.

Keywords: Adjuvant chemotherapy; Certified breast cancer unit; Early breast cancer; Neoadjuvant chemotherapy; Pathologic complete response.

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Conflict of interest statement

There are no conflicts of interests (e.g., employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, or grants, or other funding with regard to this study) for any of the authors. Ethics approval and consent to participate The study was approved by the ethics committee of the University of Heidelberg and in accordance with the Declaration of Helsinki. Because the study was deemed as without risk, including only anonymized analysis of routinely collected data, the ethics committee of the University of Heidelberg did not request approval for consent.

Figures

Fig. 1
Fig. 1
CONSORT diagram
Fig. 2
Fig. 2
Overall proportion of patients receiving chemotherapy among primary, non-metastatic breast cancer patients at Heidelberg Breast Care Unit from 2003 to 2014
Fig. 3
Fig. 3
Relative proportion of adjuvant and neoadjuvant chemotherapy at Heidelberg Breast Care Unit from 2003 to 2014
Fig. 4
Fig. 4
Relative proportion of NACT by breast cancer subtype (n = 2215, 7 missing) at Heidelberg Breast Care Unit from 2003 to 2014
Fig. 5
Fig. 5
pCR according to different definitions of pCR at Heidelberg Breast Care Unit from 2003 to 2014
Fig. 6
Fig. 6
pCR (ypT0ypN0) by breast cancer subtype at Heidelberg Breast Care Unit from 2003 to 2014. The graph shows the pCR (ypT0ypN0) among patients receiving neoadjuvant chemotherapy in the three subgroups of immunohistochemically defined breast cancer subtypes at Heidelberg Breast Care Unit from 2003 to 2014
See this image and copyright information in PMC

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