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Adjuvant extension of chemotherapy after neoadjuvant therapy may not improve outcome in early-stage breast cancer
European Journal of Surgical Oncology, 06/30/09

Knauer M et al. - In a study to investigate if extended chemotherapy (ExC) improved disease-free (DFS) and overall survival (OS) in early-stage breast cancer, it seems that 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 neoadjuvant chemotherapy (NAC) and adjuvant therapy (AdC) groups.

• 356 consecutive pts received NAC (45 pts), AdC (221 pts), or ExC (90 pts).
• These 3 groups were analyzed to determine effects of ExC and to identify pts 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 yrs with follow-up of 30, 57, and 55 mos.

• After NAC, 35% achieved downstaging and 10% pathologic complete remission.
• ExC seemed to result in reduction of 5-yr DFS: vs 85% and 82% after NAC and AdC, DFS was 61% after ExC.
• OS was not significantly affected (79, 91, and 78% after NAC, AdC and ExC).
• In multivariate analysis after correction for age, menopausal status, stage, grading, hormone receptors, HER2-status, radiotherapy, and surgery, ExC seemed to adversely affect DFS, loco-regional and distant recurrence-rates.

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