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

Journal article

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 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 with varying durations) 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. Aromatase inhibitors in premenopausal women increased death from second cancers. Conclusions These benefits and risks inform treatment decisions for individuals and recommendations for groups of women.

Authors: Kerr, AJ; Dodwell, D; McGale, P; Holt, F; Duane, F

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Cancer Treatment Reviews
• Volume: 105
• Article number: 102375
• Publication date: 2022-03-03
• Acceptance date: 2022-03-01
• DOI: 10.1016/j.ctrv.2022.102375
• ISSN: 0305-7372
• Language: English
• Keywords: FFR