Adjuvant and neoadjuvant breast cancer treatments: A systematic review of their effects on mortality

Amanda J. Kerr, David Dodwell, Paul McGale, Francesca Holt, Fran Duane, Gurdeep Mannu, Sarah C. Darby, Carolyn W. Taylor*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Citations (Scopus)

Abstract

Background: Adjuvant and neoadjuvant breast cancer treatments can reduce breast cancer mortality but may increase mortality from other causes. Information regarding treatment benefits and risks is scattered widely through the literature. To inform clinical practice we collated and reviewed the highest quality evidence. Methods: Guidelines were searched to identify adjuvant or neoadjuvant treatment options recommended in early invasive breast cancer. For each option, systematic literature searches identified the highest-ranking evidence. For radiotherapy risks, searches for dose–response relationships and modern organ doses were also undertaken. Results: Treatment options recommended in the USA and elsewhere included chemotherapy (anthracycline, taxane, platinum, capecitabine), anti-human epidermal growth factor 2 therapy (trastuzumab, pertuzumab, trastuzumab emtansine, neratinib), endocrine therapy (tamoxifen, aromatase inhibitor, ovarian ablation/suppression) and bisphosphonates. Radiotherapy options were after breast conserving surgery (whole breast, partial breast, tumour bed boost, regional nodes) and after mastectomy (chest wall, regional nodes). Treatment options were supported by randomised evidence, including > 10,000 women for eight treatment comparisons, 1,000–10,000 for fifteen and < 1,000 for one. Most treatment comparisons reduced breast cancer mortality or recurrence by 10–25%, with no increase in non-breast-cancer death. Anthracycline chemotherapy and radiotherapy increased overall non-breast-cancer mortality. Anthracycline risk was from heart disease and leukaemia. Radiation-risks were mainly from heart disease, lung cancer and oesophageal cancer, and increased with increasing heart, lung and oesophagus radiation doses respectively. Taxanes increased leukaemia risk. Conclusions: These benefits and risks inform treatment decisions for individuals and recommendations for groups of women.

Original languageEnglish
Article number102375
JournalCancer Treatment Reviews
Volume105
DOIs
Publication statusPublished - Apr 2022
Externally publishedYes

Bibliographical note

Funding Information:
The authors would like to thank patient contributors Hilary Stobart and Mairead MacKenzie on behalf of Independent Cancer Patients' Voice for helpful discussions. They would also like to thank Paul Pharoah, University of Cambridge, and Alexandra Freeman and Gabriel Recchia both at the Winton Centre for Risk and Evidence Communication for their ideas and input. This work was supported by Cancer Research UK [grant C8225/A21133], the National Institute for Health Research [grant 300676] and the National Institute for Health Research Oxford Biomedical Research Centre. The study sponsors had no role in study design, in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the paper for publication.

Funding Information:
This work was supported by Cancer Research UK [grant C8225/A21133], the National Institute for Health Research [grant 300676] and the National Institute for Health Research Oxford Biomedical Research Centre. The study sponsors had no role in study design, in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the paper for publication.

Publisher Copyright:
© 2022 The Authors

Keywords

  • Adjuvant treatments
  • Breast cancer
  • Neoadjuvant treatments
  • Treatment benefits
  • Treatment harms

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