Although pCR correlated significantly with disease-free and overall survival (P < 0.0001 and P = 0.0007, respectively), the Neo-tAnGo trial did not find that improvements in pCR associated with taxane-first sequencing translated into improved disease-free or overall survival for patients who received paclitaxel first, Drs. Colleoni and Goldhirsch noted.3

But they suspect that this is likely because of variation in tumor biology among study participants.6


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“The overall low pCR (17%) was possibly related to the heterogeneous population, which included patients with inflammatory breast cancer,” noted Drs. Colleoni and Goldhirsch.6 “Interpretation of efficacy of neoadjuvant treatments might be improved by a selective focus on specific subtypes of breast cancer. The Neo-tAnGo study, as is the case with most studies done in the neoadjuvant setting in the past few years, took no account of potential heterogeneity of tumor biology, which has been widely studied since such studies began.”

Further research is needed to clarify the role of sequencing. Drs. Colleoni and Goldhirsch—and the Neo-tAnGo authors—recommend that future clinical trials of neoadjuvant chemotherapy regimens include patients in specific prognostic groups reflecting tumor biology.3,6

The Neo-tAnGo trial was funded by Cancer Research UK, Eli Lilly, and Bristol-Myers Squibb.

References

  1. Spanheimer PM, Carr JC, Thomas A, et al. The response to neoadjuvant chemotherapy predicts clinical outcome and increases breast conversation in advanced breast cancer. Am J Surg. 2013;206(1):2-7.
  2. Redden MH, Fuhrman GM. Neoadjuvant chemotherapy in the treatment of breast cancer. Surg Clin North Am. 2013;93(2):493-499.
  3. Earl HM, Vallier AL, Hiller L, et al. Effects of the addition of gemcitabine, and paclitaxel-first sequencing, in neoadjuvant sequential epirubicin, cyclophosphamide and paclitaxel for women with high-risk early breast cancer (Neo-tAnGo): an open-label, 2×2 factorial randomised phase 3 trial. Lancet Oncol. 2014;15(2):201-212.
  4. Cortazar P, Zhang L, Untch M, et al. Meta-analysis results from the collaborative trials in neoadjuvant breast cancer (CTNeoBC). Cancer Res. 2012;72(suppl 24): Abstract S1-S11.
  5. Connolly RM, Stearns V. Current approaches for neoadjuvant chemotherapy in breast cancer. Eur J Pharmacol. 2013;717(1-3):58-66.
  6. Colleoni M, Goldhirsch A. Neoadjuvant chemotherapy for breast cancer: any progress? Lancet Oncol. 2014;15(2):131-132.
  7. von Minckwitz G, Eidtmann H, Rezai M, et al. Neoadjuvant chemotherapy and bevacizumab for HER2-negative breast cancer. N Engl J Med. 2012;366(4):299-309.
  8. McCarthy N, Boyle F, Zdenkowski N, et al. Neoadjuvant chemotherapy with sequential anthracycline-docetaxel with gemcitabine for large operable or locally advanced breast cancer: ANZ 0502 (NeoGem). Breast. 2014 Jan 3. [Epub ahead of print] doi:10.1016/j.breast.2013.12.001.