Rethinking Neoadjuvant Chemotherapy for breast cancer- Prof Jayant Vaidya
Chapters
00:00 BMJ paper: Rethinking neoadjuvant chemotherapy for breast cancer?
01:30 Chemotherapy in perspective
02:00 Why give (or not give) neoadjuvant chemotherapy?
04:13 Clinical trial results showing no-benefit and worse for local recurrencefrom neoadjuvant chemotherapy
04:48 The lack of survival benefit (vs adjuvant therapy) despite higher pCR rate
10:11 Neoadjuvant chemotherapy could be dangerous
12:26 Improving pCR does not improve breast conserving surgery rate
14:26 Problems with using KATHARINE trial data to justify NACT for HER2 positive breast cancer. Given the issues about PCR ([ Ссылка ]) - TDM-1 may benefit those with 'PCR' too - and Katherine trial excluded those with 'PCR' and 20% of them died
and then Problems with using CREATE-X trial to justify NACT for triple negative breast cancer
Original BMJ paper is at [ Ссылка ]
Full paper is available at [ Ссылка ]
Full paper + Discussion is available at [ Ссылка ]
The BMJ Podcast [ Ссылка ]
Key messages
Neoadjuvant chemotherapy is being increasingly used for breast cancer despite higher rates of local recurrence and no evidence of survival benefit, mainly because of the immediate and dramatic pathological responses seen with newer drugs
The increased pathological response of the primary tumour in the breast does not translate into a survival benefit even when given in the adjuvant setting, challenging the paradigm of “window of opportunity” studies
We must acknowledge that neoadjuvant chemotherapy may not be beneficial to breast cancer patients
We should consider reducing the widespread use of neoadjuvant chemotherapy
