Table 2.
The outline of seminal studies validating neoadjuvant chemotherapy prescription in breast cancer patients.
| Author | Year | Study | N | Patients | Arms | Findings | Journal |
|---|---|---|---|---|---|---|---|
| Fisher [58] | 1998 | NSABP B-018 phase III, RCT | 1523 | Locally advanced breast cancer | Neoadjuvant vs. adjuvant chemotherapy prescription | Overall, 13% achieved a pCR to NAC, 36% achieved a CCR, 43% achieved a PCR, and 37% of patients downstaged their axilla previously palpable LNs. Overall, patients after NAC were more likely to undergo successful BCS (67% vs. 60%, p = 0.002) | Journal of Clinical Oncology |
| Mauri [68] | 2005 | Meta-analysis of RCTs | 3946 | Early breast cancer | NAC vs. adjuvant chemotherapy | There was no difference in DP (RR: 0.99), DR (RR: 0.94), or OS (RR: 1.00) outcomes for NAC vs. adjuvant therapy. However, there were increased LRR rates following NAC (RR: 1.22) | Journal of the National Cancer Institute |
| Bear [61] | 2006 | NSABP B-027 phase III, RCT | 2411 | Early breast cancer | NAC (AC) and Docetaxel vs. AC alone | There were increased pCR rates and axillary downstaging with added neoadjuvant docetaxel, however failed to increase BCS rates, DFS, and OS outcomes overall. The addition of neoadjuvant Docetaxel increased pCR rates | Journal of Clinical Oncology |
| Van Nes [69] | 2009 | Preoperative chemotherapy in Primary Operable Breast Cancer (POCOB) | 698 | Early breast cancer | NAC vs. adjuvant chemotherapy | At 10 years of follow-up, there was no observed difference in OS, DFS, or LRR (all P>0.05); however, NAC was associated with increased BCS rates | Breast Cancer Research and Treatment |
| EBCTCG [55] | 2018 | Meta-analysis of RCTs | 4756 | Early breast cancer | NAC vs. adjuvant chemotherapy | At 15 years follow-up, NAC was associated with increased LRR rates (21.4% vs. 15.9%), however there was no difference in DR (38.2% vs. 38.0%), BCM (34.4% vs. 33.7%) and OS (40.9% vs. 41.2%) | Lancet Oncology |
N; number, RCT; randomised controlled trial, pCR: pathological complete response, NAC; CCR; complete clinical response, PCR; partial clinical response, LN; lymph nodes, BCS; breast conservation surgery, DP; disease progression, RR; rate ratio, DR; distant recurrence, OS; overall survival, DFS; disease-free survival, LRR; locoregional recurrence, AC; Doxorubicin and Cyclophosphamide, EBCTCG; early breast cancer triallist collaborative group, BCM; breast cancer mortality.