title: Adjuvant extension of chemotherapy after neoadjuvant therapy may not improve outcome in early-stage breast cancer.
abstract: BACKGROUND
  Neoadjuvant chemotherapy (NAC) is equivalent to adjuvant therapy (AdC) in terms of survival and disease-free interval. Many institutions add AdC after NAC and surgery. However, such extended chemotherapy (ExC) is not evidence based. Study aim was to investigate if ExC improved disease-free (DFS) and overall survival (OS).
  
  
  METHODS
  From 1998 to 2006 356 consecutive patients received NAC (45 pts), AdC (221 pts) or ExC (90 pts). We analysed these 3 groups to determine effects of ExC and to identify patients who might benefit. NAC consisted in 93% of 3-6 cycles of epirubicin+docetaxel, AdC comprised EC+/-taxanes in 72%. Median age in the NAC, AdC, and ExC-groups was 54, 56 and 52 years with follow-up of 30, 57, and 55 months.
  
  
  RESULTS
  After NAC, 35% achieved downstaging and 10% pathologic complete remission. Surprisingly ExC seemed to result in reduction of 5-year DFS: compared to 85% and 82% after NAC and AdC, DFS was 61% after ExC (p=0.001). OS was not significantly affected (79, 91, and 78% after NAC, AdC and ExC, p=0.13). In multivariate analysis after correction for age, menopausal status, stage, grading, hormone receptors, her2-status, radiotherapy and surgery, ExC seemed to adversely affect DFS (HR 2.15, p=0.008), loco-regional and distant recurrence-rates (HR 3.0, p=0.03 and HR 2.0, p=0.02).
  
  
  CONCLUSIONS
  In this single-center analysis ExC could not show advantages in terms of DFS and OS. Because multivariate analyses of retrospective data cannot account for all potential biases, these data require confirmation in randomized clinical trials. Until then, extended chemotherapy should be considered carefully. As in previous studies, no differences were found between NAC and AdC groups.
authors.affiliation: Department of General and Thoracic Surgery, University Teaching Hospital Feldkirch, Feldkirch, Austria. michael.knauer@lkhf.at
authors.forename: M
authors.initials: M
authors.lastname: Knauer
authors.forename: A
authors.initials: A
authors.lastname: Haid
authors.forename: Y
authors.initials: Y
authors.lastname: Schneider
authors.forename: R
authors.initials: R
authors.lastname: Köberle-Wührer
authors.forename: A
authors.initials: A
authors.lastname: Lang
authors.forename: T
authors.initials: T
authors.lastname: Winder
authors.forename: R
authors.initials: R
authors.lastname: Alton
authors.forename: Z
authors.initials: Z
authors.lastname: Jasarevic
authors.forename: C
authors.initials: C
authors.lastname: Säly
authors.forename: F A
authors.initials: FA
authors.lastname: Offner
authors.forename: E
authors.initials: E
authors.lastname: Wenzl
authors.forename: A
authors.initials: A
authors.lastname: deVries
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents