Epidemiological and clinicopathological parameters related to the neoadjuvant chemotherapy for breast cancer during the COVID-19 crisis
DOI:
https://doi.org/10.29289/2594539420240007Palavras-chave:
breast neoplasms, breast, neoadjuvant therapy, COVID-19Resumo
Breast cancer, the second-leading cause of cancer-related deaths among women worldwide, is a complex and heterogeneous disease. Its socioeconomic aspects are recognized as determinants of clinical outcomes. The COVID-19 crisis negatively affected millions, particularly in impoverished macroregions like Brazil. Thus, influences on breast cancer patients’ journey may occur, particularly in the neoadjuvant settings, in which a coordinated and multidisciplinary approach is mandatory. The present study aimed to analyze the epidemiological and clinicopathological profile of breast cancer patients who underwent neoadjuvant chemotherapy during the pandemic in Brazil. Methods: This is a unicentric, retrospective, and descriptive cross-sectional study conducted by analyzing data obtained from electronic medical records of breast cancer patients who underwent neoadjuvant chemotherapy. Results: From March 2020 to December 2022, 55 patients underwent neoadjuvant chemotherapy. They presented an average age of 50.0 years (range 43.9–47.6). About 83.6% of the tumors were invasive ductal carcinomas, and the most prevalent molecular subtype was hormone receptor-positive. T2 tumors accounted for 50.9%, while compromised N1 axillary lymph nodes represented 52.7%. The most commonly used neoadjuvant chemotherapy combined anthracyclines, cyclophosphamide, and sequential taxane. Regarding postoperative pathological response, 42.2% showed a partial response after neoadjuvant treatment, and a complete pathological response of as high as 40.0% occurred. The luminal and hybrid luminal subtypes were those that achieved the greatest response to neoadjuvant therapy. The lack of pathological response was only found in the luminal molecular subtype. Conclusions: This study demonstrated the impacts of the COVID-19 pandemic on breast cancer patients’ journey. During this period of disruption in healthcare assistance, the disease presented at more advanced stages, but the pathologic complete response was higher than expected, and influences on chemotherapy decisions were not relevant. Overall, there were efforts to keep patients in the best breast cancer care.
Downloads
Referências
Rocha R, Atun R, Massuda A, Rache B, Spinola P, Nunes L, et al. Effect of socioeconomic inequalities and vulnerabilities on health- system preparedness and response to COVID-19 in Brazil: a comprehensive analysis. Lancet Glob Health. 2021;9(6)e782-e792. https://doi.org/10.1016/S2214-109X(21)00081-4
Antonini M, Pinheiro DJPC, Matos ABTMB, Ferrado O, Mattar A, Okumua LM, et al. Impact of the COVID-19 pandemic on the breast cancer early diagnosis program in Brazil. Prev Med Rep. 2023;32:102157. https://doi.org/10.1016/j.pmedr.2023.102157
Korde LA, Somerfield MR, Carey La, Crews JR, Denduluri N, Hwang ES, et al. Neoadjuvant Chemotherapy, Endocrine Therapy and Targeted Therapy for Breast Cancer: ASCO Guideline. J Clin Oncol. 2021;39(13):1485-505. https://doi.org/10.1200/JCO.20.03399
Rastogi P, Anderson SJ, Bear HD, Geyer CE, Kahlenberg MS, Robidoux A, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project protocols B-18 and B-27. J Clin Oncol. 2008:26(5):778-85. https://doi.org/10.1200/JCO.2007.15.0235
Perou CM, Sørlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, et al. Molecular portraits of human breast tumours. Nature. 2000; 406(6797):747-52. https://doi.org/10.1038/35021093
Ministério da Saúde. Instituto Nacional de Câncer. Estimativa | 2023: incidência de câncer no Brasil. Rio de Janeiro: INCA, 2022.
Liu L, Hao X, Song Z, Zhi X, Zhang S, Zhang J. Correlation between family history and characteristics of breast cancer. Sci Rep. 2021;11(1):6360. https://doi.org/10.1038/s41598-021-85899-8
Breast Cancer Association Consortium; Dorling L, Carvalho S, Allen J, González-Neira A, Luccarini C, Wahlström C, et al. Breast Cancer Risk Genes — Association Analysis in More than 113,000 Women. N Engl J Med. 2021;384(5):428-39. https://doi.org/10.1056/NEJMoa1913948
Moura EC, Cortez-Escalante J, Cavalcante FV, Barreto ICHC, Sanchez MN, Santos LMP. Covid-19: evolução temporal e imunização nas três ondas epidemiológicas, Brasil, 2020-2022. Rev Saúde Pública. 2022;56:105. https://doi.org/10.11606/s1518-8787.2022056004907
Rubens RD, Sexton S, Tong D, Winter PJ, Knight RK, Hayward JL. Combined chemotherapy and radiotherapy for locally advanced breast cancer. Eur J Cancer 1980;16(3):351-6. https://doi.org/10.1016/0014-2964(80)90352-7
Petruolo O, Sevilimedu V, Montagna G, Le T, Morrow M, Barrio AV. How Often Does Modern Neoadjuvant Chemotherapy Downstage Patients to Breast-Conserving Surgery? Ann Surg Oncol. 2021;28(1):287-94. https://doi.org/10.1245/s10434-020-08593-5
Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164-72. https://doi.org/10.1016/S0140-6736(13)62422-8
Gianni L, Eiermann W, Semiglazov V, Manikhas A, Lluch A, Tjulandin S, et al. Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet. 2010;375(9712):377-84. https://doi.org/10.1016/S0140-6736(09)61964-4
Schneeweiss A, Chia S, Hickish T, Harvey V, Eniu A, Hegg R, et al. Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: a randomized phase II cardiac safety study (TRYPHAENA). Ann Oncol. 2013;24(9):2278-84. https://doi.org/10.1093/annonc/mdt182
Gianni L, Pienkowski T, Im YH, Roman L, Tseng LM, Liu MC, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol. 2012;13(1):25-32. https://doi.org/10.1016/S1470-2045(11)70336-9
Von Minckwitz G, Schneeweiss A, Loibl S, Salat C, Denkert C, Rezai M, et al. Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer (GeparSixto; GBG 66): a randomised phase 2 trial. Lancet Oncol. 2014;15(7):747-56. https://doi.org/10.1016/S1470-2045(14)70160-3
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018;19(1):27-39. https://doi.org/10.1016/S1470-2045(17)30777-5
Schmid P, Cortes J, Pusztai L, McArthur H, Kümmel S, Bergh J, et al. Pembrolizumab for Early Triple-Negative Breast Cancer. N Engl J Med. 2020;382(9):810-21. https://doi.org/10.1056/NEJMoa1910549
Kim HS, Yoo TK, Park WC, Chae BJ. Potential Benefits of Neoadjuvant Chemotherapy in Clinically Node-Positive Luminal Subtype − Breast Cancer. J Breast Cancer. 2019;22(3):412-24. https://doi.org/10.4048/jbc.2019.22.e35
Kim HJ, Noh WC, Lee ES, Jung YS, Kim LS, Han W, et al. Efficacy of neoadjuvant endocrine therapy compared with neoadjuvant chemotherapy in pre-menopausal patients with oestrogen receptor-positive and HER2-negative, lymph node-positive breast cancer. Breast Cancer Res. 2020;22(1):54. https://doi.org/10.1186/s13058-020-01288-5
Semiglazov VF, Semiglazov VV, Dashyan GA, Ziltsova EK, Ivanov VG, Bozhok AA, et al. Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor-positive breast cancer. Cancer. 2007;110(2):244-54. https://doi.org/10.1002/cncr.22789
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2025 Maria Fernanda da Motta Sperotto Valadares Gontijo, Letícia Martins de Araújo Campos Linhares, Luisa Lazarino de Souza Campos, Marcela de Oliveira Sá, Caroline Cançado Avelar, João Pedro Costa Apolinário, Paulo Henrique Costa Diniz, José Tadeu Campos de Avelar

Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.