Neoadjuvant and adjuvant therapy generally comparable for breast cancer

Breast cancer survival is similar whether systemic chemotherapy is given before surgery or afterward, findings from a meta-analysis of trial data indicate. However, under certain circumstances, neoadjuvant therapy may raise the risk of locoregional recurrence.

The findings, which appear in the Journal of the National Cancer Institute for February 2, are based on an analysis of data from nine randomized studies that included a total of nearly 4000 patients. Except for the operative timing, the neoadjuvant and adjuvant therapies involved the same regimen.The two types of therapy were comparable in terms of survival, disease progression, and distant disease recurrence, senior author Dr. John P. A. Ioannidis, from the University of Ioannina School of Medicine in Greece, and colleagues note. However, neoadjuvant therapy was tied to a significantly increased risk of locoregional recurrence, particularly in cases involving radiotherapy without surgery, the authors note. In patients receiving only radiotherapy, the risk of locoregional recurrence was 53% higher with neoadjuvant therapy than with adjuvant therapy. Given this finding, “we recommend avoiding the use of radiotherapy without any surgical treatment, even in the presence of an apparently good clinical response to neoadjuvant chemotherapy,” the investigators emphasize.In a related editorial, Dr. Nancy E. Davidson, from Johns Hopkins University in Baltimore, and Dr. Monica Morrow, from the Fox Chase Cancer Center in Philadelphia, support the researchers’ findings, noting that the “meta-analysis appears to be carefully performed and methodologically sound.”(Source: J Natl Cancer Inst 2005;97:159-161,188-194: Reuters Health: Oncolink: February 2005.)