Neoadjuvant systemic therapy in invasive lobular breast cancer: Is it indicated?

Am J Surg. 2018 Mar;215(3):509-512. doi: 10.1016/j.amjsurg.2017.11.011. Epub 2017 Nov 14.

Abstract

Background: This study investigated patients with invasive lobular breast carcinoma (ILC) to determine the benefit of neoadjuvant systemic therapy (NAST).

Methods: Patients with ILC treated from 2006 to 2015 were identified. Tumor characteristics and treatment data were analyzed.

Results: Of the 560 patients with ILC, 77 patients received NAST. Patients who received NAST presented with larger clinical T stages compared to patients who received surgery first (p < 0.001). Pathological complete response (pCR) to NAST was seen in 17% of patients. Only 14% of patients with clinically positive lymph nodes downstaged to N0. These patients were more likely to have HER2 positive tumors (p < 0.029) and larger tumor size at diagnosis (p < 0.015). Mastectomy was performed in 84% of patients and lumpectomy in 16%.

Conclusions: Only a minority of patients with ILC achieve pCR. The majority of patients still undergo mastectomy; therefore the benefit of NAST in ILC appears limited.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use*
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery
  • Carcinoma, Lobular / drug therapy*
  • Carcinoma, Lobular / pathology
  • Carcinoma, Lobular / surgery
  • Chemotherapy, Adjuvant
  • Female
  • Humans
  • Mastectomy*
  • Middle Aged
  • Neoadjuvant Therapy*
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Antineoplastic Agents