Preoperative chemotherapy: Updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27

Title

Preoperative chemotherapy: Updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27

Creator

Rastogi P; Anderson S J; Bear H D; Geyer C E; Kahlenberg M S; Robidoux A; Margolese R G; Hoehn J L; Vogel V G; Dakhil S R; Tamkus D; King K M; Pajon E R; Wright M J; Robert J; Paik S; Mamounas E P; Wolmark N

Publisher

Journal of Clinical Oncology

Date

2008
2008-02

Description

Purpose National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-18 was designed to determine whether four cycles of doxorubicin and cyclophosphamide (AC) administered preoperatively improved breast cancer disease-free survival (DFS) and overall survival (OS) compared with AC administered postoperatively. Protocol B-27 was designed to determine the effect of adding docetaxel (T) to preoperative AC on tumor response rates, DFS, and OS. Patients and Methods Analyses were limited to eligible patients. In B-18, 751 patients were assigned to receive preoperative AC, and 742 patients were assigned to receive postoperative AC. In B-27, 784 patients were assigned to receive preoperative AC followed by surgery, 783 patients were assigned to AC followed by T and surgery, and 777 patients were assigned to AC followed by surgery and then T. Results Results from B-18 show no statistically significant differences in DFS and OS between the two groups. However, there were trends in favor of preoperative chemotherapy for DFS and OS in women less than 50 years old (hazard ratio [HR] = 0.85, P = .09 for DFS; HR = 0.81, P = .06 for OS). DFS conditional on being event free for 5 years also demonstrated a strong trend in favor of the preoperative group (HR = 0.81, P = .053). Protocol B-27 results demonstrated that the addition of T to AC did not significantly impact DFS or OS. Preoperative T added to AC significantly increased the proportion of patients having pathologic complete responses (pCRs) compared with preoperative AC alone (26% v 13%, respectively; P < .0001). In both studies, patients who achieved a pCR continue to have significantly superior DFS and OS outcomes compared with patients who did not. Conclusion B-18 and B-27 demonstrate that preoperative therapy is equivalent to adjuvant therapy. B-27 also showed that the addition of preoperative taxanes to AC improves response.

Subject

cancer patients; chemotherapy; competing risk; conservative treatment; estrogen-receptor status; expressing estrogen; induction; multimodal; neoadjuvant chemotherapy; Oncology; radiation-therapy; treatment; tumor response

Format

Journal Article

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Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

778-785

Issue

5

Volume

26

Citation

Rastogi P; Anderson S J; Bear H D; Geyer C E; Kahlenberg M S; Robidoux A; Margolese R G; Hoehn J L; Vogel V G; Dakhil S R; Tamkus D; King K M; Pajon E R; Wright M J; Robert J; Paik S; Mamounas E P; Wolmark N, “Preoperative chemotherapy: Updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27,” NEOMED Bibliography Database, accessed April 21, 2021, https://neomed.omeka.net/items/show/6844.

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