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Trends in Use of Neoadjuvant Systemic Therapy in Patients with Clinically Node-positive Breast Cancer in Europe: Prospective TAXIS Study (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101)

Abstract

Purpose: The aim of this study was to evaluate clinical practice heterogeneity in use of neoadjuvant systemic therapy (NST) for patients with clinically node-positive breast cancer in Europe.

Methods: The study was preplanned in the international multicenter phase-III OPBC-03/TAXIS trial (ClinicalTrials.gov Identifier: NCT03513614) to include the first 500 randomized patients with confirmed nodal disease at the time of surgery. The TAXIS study's pragmatic design allowed both the neoadjuvant and adjuvant setting according to the preferences of the local investigators who were encouraged to register eligible patients consecutively.

Results: A total of 500 patients were included at 44 breast centers in six European countries from August 2018 to June 2022, 165 (33%) of whom underwent NST. Median age was 57 years (interquartile range [IQR], 48-69). Most patients were postmenopausal (68.4%) with grade 2 and 3 hormonal receptor-positive and human epidermal growth factor receptor 2-negative breast cancer with a median tumor size of 28 mm (IQR 20-40). The use of NST varied significantly across the countries (p < 0.001). Austria (55.2%) and Switzerland (35.8%) had the highest percentage of patients undergoing NST and Hungary (18.2%) the lowest. The administration of NST increased significantly over the years (OR 1.42; p < 0.001) and more than doubled from 20 to 46.7% between 2018 and 2022.

Conclusion: Substantial heterogeneity in the use of NST with HR+/HER2-breast cancer exists in Europe. While stringent guidelines are available for its use in triple-negative and HER2+ breast cancer, there is a need for the development of and adherence to well-defined recommendations for HR+/HER2-breast cancer.

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References
1.
Nguyen T, Hoskin T, Day C, Degnim A, Jakub J, Hieken T . Decreasing Use of Axillary Dissection in Node-Positive Breast Cancer Patients Treated with Neoadjuvant Chemotherapy. Ann Surg Oncol. 2018; 25(9):2596-2602. DOI: 10.1245/s10434-018-6637-9. View

2.
Boileau J, Poirier B, Basik M, Holloway C, Gaboury L, Sideris L . Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol. 2014; 33(3):258-64. DOI: 10.1200/JCO.2014.55.7827. View

3.
Boland M, Al-Maksoud A, Ryan E, Balasubramanian I, Geraghty J, Evoy D . Value of a 21-gene expression assay on core biopsy to predict neoadjuvant chemotherapy response in breast cancer: systematic review and meta-analysis. Br J Surg. 2021; 108(1):24-31. DOI: 10.1093/bjs/znaa048. View

4.
Burstein H, Curigliano G, Thurlimann B, Weber W, Poortmans P, Regan M . Customizing local and systemic therapies for women with early breast cancer: the St. Gallen International Consensus Guidelines for treatment of early breast cancer 2021. Ann Oncol. 2021; 32(10):1216-1235. PMC: 9906308. DOI: 10.1016/j.annonc.2021.06.023. View

5.
. Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2017; 19(1):27-39. PMC: 5757427. DOI: 10.1016/S1470-2045(17)30777-5. View