title: Outcome after neoadjuvant chemotherapy in young breast cancer patients: a pooled analysis of individual patient data from eight prospectively randomized controlled trials.
abstract: Young women with breast cancer (BC) have a worse survival partly due to more aggressive tumor characteristics; however, their response to chemotherapy seems better. We investigated to what extent the prognostic factor pathological complete remission (pCR) after neoadjuvant chemotherapy is applicable to young women. 8949 patients with primary BC and follow-up from eight German neoadjuvant trials were included. A subgroup of 1453 patients <40 years was compared with women aged 40-49 and ≥50 years regarding pCR (ypT0 ypN0), as well as disease free survival (DFS), local recurrence free survival (LRFS), distant disease free survival (DDFS), and overall survival (OS) overall, according to pCR status and subtypes defined by hormone-receptor (HR) status and HER2. pCR was strongly associated with age without a clear age cut-off. The pCR rate was significantly higher in the young compared with other age groups (20.9 vs. 17.7 vs. 13.7 %; p < 0.001). This difference was confined to triple-negative breast cancer (TNBC) and HR +/HER2-. DFS, DDFS, LRFS, and OS were significantly worse for young women. Age was independently prognostic for survival in HR +/HER2-, with women <40 years without pCR having a worse DFS compared to their counterparts with pCR. Young women are more likely to achieve pCR after neoadjuvant chemotherapy, especially in HR +/HER2- and TNBC. Age is not an important prognostic factor in TNBC and HR-/HER2 + but is in HR +/HER2-. Young women with a luminal-like BC seem to benefit more from neoadjuvant chemotherapy than older women, which needs to be taken into account.
authors.affiliation: German Breast Group, c/o GBG Forschungs GmbH, Martin-Behaim-Straße 12, 63263, Neu-Isenburg, Germany, sibylle.loibl@gbg.de.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Loibl
authors.forename: Christian
authors.initials: C
authors.lastname: Jackisch
authors.forename: Bianca
authors.initials: B
authors.lastname: Lederer
authors.forename: Michael
authors.initials: M
authors.lastname: Untch
authors.forename: Stefan
authors.initials: S
authors.lastname: Paepke
authors.forename: Sherko
authors.initials: S
authors.lastname: Kümmel
authors.forename: Andreas
authors.initials: A
authors.lastname: Schneeweiss
authors.forename: Jens
authors.initials: J
authors.lastname: Huober
authors.forename: Jörn
authors.initials: J
authors.lastname: Hilfrich
authors.forename: Claus
authors.initials: C
authors.lastname: Hanusch
authors.forename: Bernd
authors.initials: B
authors.lastname: Gerber
authors.forename: Holger
authors.initials: H
authors.lastname: Eidtmann
authors.forename: Carsten
authors.initials: C
authors.lastname: Denkert
authors.forename: Serban Dan
authors.initials: SD
authors.lastname: Costa
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Blohmer
authors.forename: Valentina
authors.initials: V
authors.lastname: Nekljudova
authors.forename: Keyur
authors.initials: K
authors.lastname: Mehta
authors.forename: Gunter
authors.initials: G
authors.lastname: von Minckwitz
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor