The use of neoadjuvant systemic therapies in breast cancer in Australia and New Zealand: Breast Surgeons of Australia and New Zealand quality audit. Issue 4 (13th March 2023)

• Record Type: Journal Article
• Authors: Duffield, Jaime A.; Blanch, Adam J.; Esterman, Adrian; Bochner, Melissa A.
• Is Part Of: ANZ journal of surgery. Volume 93:Issue 4(2023)
• Page Start: 889
• Page End: 895
• Publication Date: 2023-03-13
• Subjects: audit -- Australia -- breast cancer -- herceptin -- neo‐adjuvant chemotherapy -- New Zealand -- quality indicator; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.18367
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Background: Breast surgeons must maintain contemporary knowledge regarding appropriate referral for neoadjuvant chemotherapy (NACT) in breast cancer (BC) patients. To date, the greatest benefit is seen in stage II–III HER2‐enriched and triple negative breast cancers (TNBC). This study is the first audit of use of NACT in Australia and New Zealand to stratify data by BC biological subtype. Methods: Prospective data from 116, 745 patients between 2010 and 2019 was provided by the Breast Surgeons of Australia and New Zealand (BreastSurgANZ) Quality Audit (BQA) of Breast Cancer Care. Annual rates of NACT use were determined and change across time analysed with fractional regression. Data from 2018 to 2019 were combined and stratified by biological subtype (LumA, LumB HER2‐neg, LumB HER2‐pos, HER2 enriched, TNBC, Other basal‐like), and age (<50, 51–74, and ≥75 years) and compared using negative binomial regression. Results: The use of NACT increased annually (OR 1.26, P < 0.001), and the use of additional adjuvant chemotherapy (ACT) decreased (OR 0.78, P < 0.001). A significantly greater use of NACT was noted in patients with TNBC and HER2+ BC, and in all patients aged <50 years compared with older ages ( P < 0.001), regardless of biological subtype. Conclusion: Increased uptake of NACT and decreased use of additional ACT is in keeping with progressive change in practice in response to contemporary evidence. Expansion of BQA data fields related to use of NACT, and detailed audit of NACT rates in Stage II–III TNBC and HER2 enriched BC will allow accurate determination of quality of practice in ANZ. Abstract : Breast surgeons must maintain contemporary knowledge regarding appropriate referral of breast cancer patients for neoadjuvant chemotherapy (NACT). The 2019 St Gallen International Consensus Guidelines for the primary therapy of early breast cancer and the ASCO Guidelines of 2021 state that NACT is now considered the preferred initial approach in women with stage II–III, triple‐negative or HER2 positive breast cancer. This manuscript describes an annual increase in use of NACT, and a corresponding annual decrease in adjuvant chemotherapy in all breast cancer biological subtypes in concordance with an uptake of contemporary guidelines in ANZ, and highlights a need for expansion of BQA data fields related to use of NACT to allow detailed audit of NACT rates in stage II–III TNBC and HER2 enriched BC, and accurate determination of quality of practice in ANZ.