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Home > Understanding Breast Cancer > Breast Cancer Research > Table 46: Neoadjuvant chemotherapy for women with stage II or stage III breast cancer

  


Table 46: Neoadjuvant chemotherapy for women with stage II or stage III breast cancer

This summary table contains detailed information about research studies. Summary tables offer an informative look at the science behind many breast cancer guidelines and recommendations. However, they should be viewed with some caution. In order to read and interpret research tables successfully, it is important to understand some key concepts. Learn how to read a research table.

Introduction: Some women with stage II or stage III breast cancer may get chemotherapy before breast surgery (called neoadjuvant chemotherapy).  Neoadjuvant chemotherapy can shrink tumors such that a lumpectomy (breast-conserving surgery) becomes an option to a mastectomy.

Learn more about neoadjuvant chemotherapy.

Neoadjuvant trastuzumab

For women with HER2/neu-positive breast cancer, neoadjuvant trastuzumab (Herceptin) may be added to neoadjuvant chemotherapy [1-3].

Learn more about trastuzumab (Herceptin)

Learn about the strengths and weaknesses of different types of studies.

Study selection criteria: Randomized controlled trials with at least 100 participants and meta-analyses.

Table note: These studies looked at different chemotherapy drug regimens, so results cannot be compared directly to one another. However, for each study, the neoadjuvant and adjuvant chemotherapy drug regimens are the same.

Study 

Study Population
(number of participants)
 

Stage of Breast Cancer  

Median Follow-up (years) 

Chemotherapy Drug Regimen 

Survival and Rate of Lumpectomy with Neoadjuvant Chemotherapy 

Randomized controlled trials 

NSABP B-18 [4]

1,493

T1-T3, N0-N1, M0

9.5

Doxorubicin, cyclophosphamide

Overall survival at 9 years:
69% with neoadjuvant therapy vs. 70% with adjuvant therapy.

Disease-free survival at 9 years: 55% with neoadjuvant therapy vs. 53% with adjuvant therapy.

Percentage of women with planned mastectomy who had lumpectomy instead: 15.9%

Gianni et al. [5]

902

T2-T3, N0-N1, M0

6.3

Doxorubicin, cyclophosphamide, methotrexate, 5-fluorouracil, paclitaxel

Disease-free survival at 6 years:
No difference between the two groups.

Overall survival at 6 years:
No difference between the two groups.

van der Hage et al. [6]

698

T1c, T2, T3, T4b, N0-N1, M0

4.7

Fluorouracil, epirubicin, cyclophosphamide

Overall survival at 4 years: 82% with neoadjuvant therapy vs. 84% with adjuvant therapy.

Progression-free survival at 4 years:
65% with neoadjuvant therapy vs. 70% with adjuvant therapy.

Percentage of women with planned mastectomy who had lumpectomy instead: 23%

Broët et al. [7]

390 premenopausal women

T2-T3, N0-N1, M0

8.8

Cyclophosphamide, doxorubicin, and 5-fluorouracil

Overall survival at 10 years: 64.6% with neoadjuvant therapy vs. 60.2% with adjuvant therapy.  

Mauriac et al. [8]

272

T2,>3 cm or

T3, N0-1, M0

10.3

Epirubicin, vincristine, methotrexate, mitomycin, thiotepa, vindesine

Overall survival at 10 years: No difference between the two groups.

Gazet et al. [9]

210

T1-T4, N0, N1-N2

5

ER+ cancers: hormone therapy

ER- cancers: mitozantrone, mitomycin, methotrexate

Premenopausal cancers: goserelin

Postmenopausal cancers: formestane

Overall survival at 5 years: 79% with neoadjuvant therapy vs. 87% with adjuvant therapy.

Disease-free survival at 5 years: No difference between the two groups.

Lumpectomy rate: 60% had a less invasive surgery with neoadjuvant therapy.

Meta-analyses 

Mieog et al. [10]

5,500

Stage I-III

 

Various

Overall survival: No difference between the two groups.

Recurrence: No difference between the two groups.

Lumpectomy rate: 26% had a less invasive surgery with neoadjuvant therapy.

References 

1. National Comprehensive Cancer Network. NCCN Clinical practices guidelines in oncology: Breast cancer. V.3.2013. http://www.nccn.org, 2013.

2. Gianni L, Eiermann W, Semiglazov V, et al. Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet. 375(9712):377-84, 2010.

3. Untch M, Rezai M, Loibl S, et al. Neoadjuvant treatment with trastuzumab in HER2-positive breast cancer: results from the GeparQuattro study. J Clin Oncol. 28(12):2024-31, 2010.

4. Wolmark N, Wang J, Mamounas E, et al. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. (30):96-102, 2001.

5. Gianni L, Baselga J, Eiermann W, et al. Phase III trial evaluating the addition of paclitaxel to doxorubicin followed by cyclophosphamide, methotrexate, and fluorouracil, as adjuvant or primary systemic therapy: European Cooperative Trial in Operable Breast Cancer. J Clin Oncol. 27(15):2474-81, 2009.

6. van der Hage JA, van de Velde CJH, Julien JP, et al. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol. 19(22):4224-37, 2001.

7. Broët P, Scholl SM, de la Rochefordière A, et al. Short and long-term effects on survival in breast cancer patients treated by primary chemotherapy: an updated analysis of a randomized trial. Breast Cancer Res Treat. 58(2):151-6, 1999.

8. Mauriac L, MacGrogan G, Avril A, et al. Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up. Institut Bergonie Bordeaux Groupe Sein (IBBGS). Ann Oncol. 10(1):47-52, 1999.

9. Gazet JC, Ford HT, Gray R, et al. Estrogen-receptor-directed neoadjuvant therapy for breast cancer: results of a randomised trial using formestane and methotrexate, mitozantrone and mitomycin C (MMM) chemotherapy. Ann Oncol. 12(5):685-91, 2001.

10. Mieog JS, van der Hage JA, van de Velde CJ. Neoadjuvant chemotherapy for operable breast cancer. Br J Surg. 94(10):1189-200, 2007.

Updated 01/13/14