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. 2024 Jan;203(2):317-328.
doi: 10.1007/s10549-023-07114-8. Epub 2023 Oct 20.

National trends in neoadjuvant chemotherapy utilization in patients with early-stage node-negative triple-negative breast cancer: the impact of the CREATE-X trial

Christine Rogers  1 , Adrienne N Cobb  1 , Jan I C Lloren  2 , Lubna N Chaudhary  3   4 , Morgan K Johnson  1 , Chiang-Ching Huang  2 , Mediget Teshome  5 , Amanda L Kong  1   4 , Puneet Singh  5 , Chandler S Cortina  6   7
Affiliations

National trends in neoadjuvant chemotherapy utilization in patients with early-stage node-negative triple-negative breast cancer: the impact of the CREATE-X trial

Christine Rogers et al. Breast Cancer Res Treat. 2024 Jan.

Abstract

Purpose: Neoadjuvant chemotherapy (NAC) for triple-negative breast cancer (TNBC) allows for assessment of tumor pathological response and has survival implications. In 2017, the CREATE-X trial demonstrated survival benefit with adjuvant capecitabine in patients TNBC and residual disease after NAC. We aimed to assess national rates of NAC for cT1-2N0M0 TNBC before and after CREATE-X and examine factors associated with receiving NAC vs adjuvant chemotherapy (AC).

Methods: A retrospective cohort study of women with cT1-2N0M0 TNBC diagnosed from 2014 to 2019 in the National Cancer Database (NCDB) was performed. Variables were analyzed via ANOVA, Chi-squared, Fisher Exact tests, and a multivariate linear regression model was created.

Results: 55,633 women were included: 26.9% received NAC, 52.4% AC, and 20.7% received no chemotherapy (median ages 53, 59, and 71 years, p < 0.01). NAC utilization significantly increased over time: 19.5% in 2014-15 (n = 3,465 of 17,777), 27.1% in 2016-17 (n = 5,140 of 18,985), and 33.6% in 2018-19 (n = 6,337 of 18,871, p < 0.001). On multivariate analysis, increased NAC was associated with younger age (< 50), non-Hispanic white race/ethnicity, lack of comorbidities, cT2 tumors, care at an academic or integrated-network cancer program, and diagnosis post-2017 (p < 0.05 for all). Patients with government-provided insurance were less likely to receive NAC (p < 0.01). Women who traveled > 60 miles for treatment were more likely to receive NAC (p < 0.01).

Conclusion: From 2014 to 2019, NAC utilization increased for patients with cT1-2N0M0 TNBC. Racial, socioeconomic, and access disparities were observed in who received NAC vs AC and warrants interventions to ensure equitable care.

Keywords: Breast cancer; CREATEX; Cancer disparities; Disparities; Early-stage breast cancer; Healthcare access; Neoadjuvant chemotherapy; Triple-negative breast cancer.

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Conflict of interest statement

Conflict of interest The authors have no relevant disclosures to report.

Figures

Fig. 1
Fig. 1
Consort diagram for cohort inclusion and exclusion data
Fig. 2
Fig. 2
Rates of women receiving neoadjuvant chemotherapy in surgically managed cT1-2N0M0 TNBC, by year of clinical diagnosis from the NCDB
Fig. 3
Fig. 3
Rates of women receiving neoadjuvant chemotherapy in surgically managed cT1–2N0M0 TNBC, by year of clinical diagnosis and specific clinical T stage from the NCDB. Key: NAC neoadjuvant chemotherapy, TNBC triple-negative breast cancer
See this image and copyright information in PMC

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