Danilo Giffoni M M Mata, Rinku Sutradhar, Matthew Castelo, Ezra Hahn, Lena Nguyen, Danielle Rodin, Omolara Fatiregun, Sabina Trebinjac, Lawrence Paszat, Andrea Eisen, Katarzyna J Jerzak, Eileen Rakovitch
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A paucity of data exists on the extent to which anthracyclines are omitted in the neoadjuvant setting and its associated effectiveness.</p><p><strong>Objective: </strong>To investigate the extent to which anthracycline-free NAC is used in the treatment of breast cancer and the impact of its omission on risks of mortality.</p><p><strong>Methods: </strong>Population-based analysis of individuals diagnosed with stage I-III invasive breast cancer between 2012 and 2021 treated with NAC and surgery in Ontario, Canada. Baseline characteristics of patients who did and did not receive an anthracycline were compared. Five-year cumulative risks of breast cancer and all-cause mortality were calculated. Cause-specific hazard ratios (HRs) and 95% CIs were calculated using adjusted multivariable proportional hazards models for the whole cohort and subsets stratified by stage and receptor subtype.</p><p><strong>Results: </strong>The cohort includes 6672 patients; 6126 received an anthracycline, 546 received an anthracycline-free regimen. Median follow-up was 3.9 years. The 5-year cumulative incidence of breast cancer mortality was 12.3% for individuals treated with an anthracycline-free regimen and 14.5% for those who received an anthracycline (p = 0.10). On multivariable analysis, individuals treated with non-anthracycline NAC did not experience an increased risk of breast cancer mortality (HR = 0.88; 95% CI: 0.65,1.18, p = 0.38) or all-cause mortality (HR 0.86; 95% CI 0.67, 1.10, p = 0.23). For patients with stage I or II HER2+ disease, treatment with non-anthracycline NAC was associated with excellent survival.</p><p><strong>Conclusions: </strong>Most individuals treated with NAC received an anthracycline but its omission for selected patients with early HER2+ breast cancer was associated with excellent outcomes.</p>","PeriodicalId":9133,"journal":{"name":"Breast Cancer Research and Treatment","volume":" ","pages":"335-346"},"PeriodicalIF":3.0000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Omission of anthracyclines from neoadjuvant chemotherapy for breast cancer: a population-based analysis.\",\"authors\":\"Danilo Giffoni M M Mata, Rinku Sutradhar, Matthew Castelo, Ezra Hahn, Lena Nguyen, Danielle Rodin, Omolara Fatiregun, Sabina Trebinjac, Lawrence Paszat, Andrea Eisen, Katarzyna J Jerzak, Eileen Rakovitch\",\"doi\":\"10.1007/s10549-025-07778-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Most individuals diagnosed with high-risk breast cancer are treated with anthracycline-containing neoadjuvant chemotherapy (NAC). 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Cause-specific hazard ratios (HRs) and 95% CIs were calculated using adjusted multivariable proportional hazards models for the whole cohort and subsets stratified by stage and receptor subtype.</p><p><strong>Results: </strong>The cohort includes 6672 patients; 6126 received an anthracycline, 546 received an anthracycline-free regimen. Median follow-up was 3.9 years. The 5-year cumulative incidence of breast cancer mortality was 12.3% for individuals treated with an anthracycline-free regimen and 14.5% for those who received an anthracycline (p = 0.10). On multivariable analysis, individuals treated with non-anthracycline NAC did not experience an increased risk of breast cancer mortality (HR = 0.88; 95% CI: 0.65,1.18, p = 0.38) or all-cause mortality (HR 0.86; 95% CI 0.67, 1.10, p = 0.23). For patients with stage I or II HER2+ disease, treatment with non-anthracycline NAC was associated with excellent survival.</p><p><strong>Conclusions: </strong>Most individuals treated with NAC received an anthracycline but its omission for selected patients with early HER2+ breast cancer was associated with excellent outcomes.</p>\",\"PeriodicalId\":9133,\"journal\":{\"name\":\"Breast Cancer Research and Treatment\",\"volume\":\" \",\"pages\":\"335-346\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Breast Cancer Research and Treatment\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10549-025-07778-4\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/13 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Breast Cancer Research and Treatment","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10549-025-07778-4","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/13 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：大多数被诊断为高危乳腺癌的个体接受含蒽环类药物的新辅助化疗（NAC）治疗。有兴趣确定哪些人可以避免使用蒽环类药物。关于蒽环类药物在新辅助治疗中被忽略的程度及其相关有效性的数据缺乏。目的：探讨不含蒽环类药物NAC在乳腺癌治疗中的应用程度及其对死亡风险的影响。方法：对2012年至2021年间在加拿大安大略省接受NAC和手术治疗的I-III期浸润性乳腺癌患者进行基于人群的分析。比较了接受和未接受蒽环类药物治疗的患者的基线特征。计算了乳腺癌的5年累积风险和全因死亡率。采用校正后的多变量比例风险模型计算全队列和按分期和受体亚型分层的亚群的病因特异性风险比（hr）和95% ci。结果：该队列包括6672例患者；6126人接受了蒽环类药物治疗，546人接受了无蒽环类药物治疗。中位随访时间为3.9年。无蒽环类药物治疗组乳腺癌5年累积死亡率为12.3%，接受蒽环类药物治疗组为14.5% （p = 0.10）。在多变量分析中，接受非蒽环类NAC治疗的个体没有经历乳腺癌死亡率增加的风险(HR = 0.88；95% CI: 0.65,1.18, p = 0.38)或全因死亡率(HR 0.86；95% CI 0.67, 1.10, p = 0.23)。对于I期或II期HER2+疾病患者，非蒽环类NAC治疗与极好的生存率相关。结论：大多数接受NAC治疗的患者接受了蒽环类药物治疗，但对早期HER2+乳腺癌患者的遗漏与良好的预后相关。
Omission of anthracyclines from neoadjuvant chemotherapy for breast cancer: a population-based analysis.
Background: Most individuals diagnosed with high-risk breast cancer are treated with anthracycline-containing neoadjuvant chemotherapy (NAC). There is interest to identify individuals for whom anthracyclines can be avoided. A paucity of data exists on the extent to which anthracyclines are omitted in the neoadjuvant setting and its associated effectiveness.
Objective: To investigate the extent to which anthracycline-free NAC is used in the treatment of breast cancer and the impact of its omission on risks of mortality.
Methods: Population-based analysis of individuals diagnosed with stage I-III invasive breast cancer between 2012 and 2021 treated with NAC and surgery in Ontario, Canada. Baseline characteristics of patients who did and did not receive an anthracycline were compared. Five-year cumulative risks of breast cancer and all-cause mortality were calculated. Cause-specific hazard ratios (HRs) and 95% CIs were calculated using adjusted multivariable proportional hazards models for the whole cohort and subsets stratified by stage and receptor subtype.
Results: The cohort includes 6672 patients; 6126 received an anthracycline, 546 received an anthracycline-free regimen. Median follow-up was 3.9 years. The 5-year cumulative incidence of breast cancer mortality was 12.3% for individuals treated with an anthracycline-free regimen and 14.5% for those who received an anthracycline (p = 0.10). On multivariable analysis, individuals treated with non-anthracycline NAC did not experience an increased risk of breast cancer mortality (HR = 0.88; 95% CI: 0.65,1.18, p = 0.38) or all-cause mortality (HR 0.86; 95% CI 0.67, 1.10, p = 0.23). For patients with stage I or II HER2+ disease, treatment with non-anthracycline NAC was associated with excellent survival.
Conclusions: Most individuals treated with NAC received an anthracycline but its omission for selected patients with early HER2+ breast cancer was associated with excellent outcomes.
期刊介绍：
Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.
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