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Chemotherapy Before Surgery May Be Most Beneficial in Very Young Women

Clearest evidence seen in women 35 or younger

January 28, 2013

Written By Robin Warshaw, Contributing Writer
Reviewed By Kathryn J. Ruddy, MD, MPH

Women age 35 and younger who receive chemotherapy before surgery were more likely to have a complete response—no cancer found in the treated breast—after that pre-surgical therapy than were older women, according to a new study.

German researchers presented the study of pre-surgical, or neoadjuvant, chemotherapy at the 2012 San Antonio Breast Cancer Symposium. The research has not yet been published in a peer-reviewed journal.

Background and Reason for the Study

When chemotherapy is part of a breast cancer treatment plan, it often is given after surgery. Yet some women may receive neoadjuvant chemotherapy instead. This before-surgery treatment may be used to shrink the tumor, sometimes enabling a lumpectomy instead of a mastectomy. Neoadjuvant chemotherapy also gives doctors information about a cancer’s sensitivity to treatment. 

The researchers of this study were seeking to learn if there are differences in how younger and older women respond to neoadjuvant chemotherapy.

Age-related differences in treatment response are important to understand. Young women are less likely to be diagnosed with breast cancer than older women. Yet young women often have more aggressive types of breast cancer, such as triple-negative (not sensitive to hormones) and luminal B (sensitive to hormones but growing relatively quickly compared to other hormone-sensitive breast cancers).  

Study Structure

Data on women with invasive, non-metastatic breast cancer who were treated with neoadjuvant chemotherapy were gathered from eight German studies. All women with hormone-sensitive breast cancer received hormonal therapy. The data were analyzed by age as well as by biological subtype.

Women age 35 or younger were compared to older women with regard to:  

  • Pathologic complete response (pCR), when no cancer can be found in the breast after treatment
  • Disease-free survival (DFS), the length of time a person is known to be alive after treatment with no return of breast cancer

Findings

Of the 8,949 women in the study, 704 were age 35 or younger. Compared to women older than 35, the younger women had:

  • More triple-negative breast cancer
    • 26 percent versus 19 percent
  • Less luminal A breast cancer (hormonally-sensitive breast cancer that typically grows more slowly than luminal B breast cancer)
    • 21 percent versus 27 percent
  • A significantly higher rate of pCR after neoadjuvant chemotherapy, suggesting that the cancers were more sensitive to the treatment
    • 23.6 percent pCR in very young women versus15.7 percent in older women
    • The women with triple-negative breast cancer accounted for much of this difference: 45 percent of young women with triple-negative disease experienced a pCR but only 31 percent of older women did

Looking at disease-free survival (DFS), the researchers found:

  • No age-related difference in DFS for triple-negative breast cancer when women had a pCR
    • DFS was significantly worse for young women when they did not have a pCR
    • Among all women with luminal A breast cancer in this study:
      • pCR only predicted DFS in young women
      • Young women with pCR had the best DFS

What This Means for You

Many factors go into deciding the elements of your treatment plan. Ask your doctor about the biological subtype and tumor characteristics of the breast cancer related to your diagnosis. Those will help determine which treatments would be appropriate.

Neoadjuvant chemotherapy may be a good option for you, particularly if you are young. If you have already had chemotherapy, or are older, talk with your doctor about the best treatment possibilities for you going forward.

To learn more about triple-negative breast cancer, read the free LBBC Guide to Understanding Triple-Negative Breast Cancer

Loibl S, Jackisch C, Gade S, et al. Neoadjuvant Chemotherapy in the Very Young: 35 Years of Age or Younger. Publication #S3-1. San Antonio Breast Cancer Symposium; Dec. 6, 2012.

This article was supportedby Cooperative Agreement Number DP11-1111 from The Centers for Disease Controland Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Denver, CO  ·  September 13, 2014

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