Research table: Neoadjuvant chemotherapy for invasive breast cancer treatment

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: Some women with invasive breast cancer may get chemotherapy before breast surgery. This is called neoadjuvant chemotherapy. 

Neoadjuvant chemotherapy may shrink a large tumor enough so a lumpectomy (breast-conserving surgery) becomes an option to a mastectomy. In some cases, response to neoadjuvant chemotherapy can help guide treatment after breast cancer surgery.

Learn more about neoadjuvant chemotherapy.

Learn about the strengths and weaknesses of different types of studies.

Study selection criteria: Randomized controlled trials with at least 100 participants and meta-analyses.

Table note: These studies looked at different chemotherapy drug regimens, so their results can’t be compared directly to one another. However, for each study, the neoadjuvant and adjuvant (after surgery) chemotherapy drug regimens were the same.

Study	Study Population (number of participants)	Stage of Breast Cancer	Median Follow-up (years)	Chemotherapy Drug Regimen	Survival and Rate of Lumpectomy with Neoadjuvant Chemotherapy
Randomized controlled trials
NSABP B-18 [1]	1,493	T1-T3, N0-N1, M0	10	Doxorubicin, cyclophosphamide	Overall survival at 9 years: 69% with neoadjuvant therapy and 70% with adjuvant therapy Disease-free survival at 9 years: 55% with neoadjuvant therapy and 53% with adjuvant therapy Percentage of women with planned mastectomy who had lumpectomy instead: 16%
Gianni et al. [2]	902	T2-T3, N0-N1, M0	6	Doxorubicin, cyclophosphamide, methotrexate, 5-fluorouracil, paclitaxel	Disease-free survival at 6 years: No difference between the 2 groups Overall survival at 6 years: No difference between the 2 groups
van der Hage et al. [3]	698	T1c, T2, T3, T4b, N0-N1, M0	5	Fluorouracil, epirubicin, cyclophosphamide	Overall survival at 4 years: 82% with neoadjuvant therapy and 84% with adjuvant therapy Progression-free survival at 4 years: 65% with neoadjuvant therapy and 70% with adjuvant therapy Percentage of women with planned mastectomy who had lumpectomy instead: 23%
Golshan et al. [4]	141 women with triple negative breast cancer	T1-T4a, N0-N2	Until surgery	Paclitaxel (with or without carboplatin and/or veliparib), doxorubicin and cyclophosphamide	Percentage of women with planned mastectomy who had the option of lumpectomy instead: 53%
Gazet et al. [5]	210	T1-T4, N0, N1-N2	5	Estrogen receptor-positive cancers: hormone therapy Estrogen receptor-negative cancers: mitozantrone, mitomycin, methotrexate Premenopausal cancers: goserelin Postmenopausal cancers: formestane	Overall survival at 5 years: 79% with neoadjuvant therapy and 87% with adjuvant therapy Disease-free survival at 5 years: No difference between the 2 groups Lumpectomy rate: 60% had a less invasive surgery with neoadjuvant therapy
Meta-analyses
Chen et al. [6]	12 studies	Stage I-III		Various	Overall survival: No difference between the 2 groups Breast cancer recurrence: No difference between the 2 groups
Mieog et al. [7]	10 studies	Stage I-III		Various	Overall survival: No difference between the 2 groups Breast cancer recurrence: No difference between the 2 groups Lumpectomy rate: 26% had a less invasive surgery with neoadjuvant therapy

References

1. Wolmark N, Wang J, Mamounas E, et al. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. (30):96-102, 2001.
2. Gianni L, Baselga J, Eiermann W, et al. Phase III trial evaluating the addition of paclitaxel to doxorubicin followed by cyclophosphamide, methotrexate, and fluorouracil, as adjuvant or primary systemic therapy: European Cooperative Trial in Operable Breast Cancer. J Clin Oncol. 27(15):2474-81, 2009.
3. van der Hage JA, van de Velde CJH, Julien JP, et al. Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol. 19(22):4224-37, 2001.
4. Golshan M, Loibl S, Wong SM, et al. Breast conservation after neoadjuvant chemotherapy for triple-negative breast cancer: surgical results from the BrighTNess randomized clinical trial. JAMA Surg. 155(3):e195410, 2020.
5. Gazet JC, Ford HT, Gray R, et al. Estrogen-receptor-directed neoadjuvant therapy for breast cancer: results of a randomised trial using formestane and methotrexate, mitozantrone and mitomycin C (MMM) chemotherapy. Ann Oncol. 12(5):685-91, 2001.
6. Chen Y, Shi XE, Tian JH, Yang XJ, Wang YF, Yang KH. Survival benefit of neoadjuvant chemotherapy for resectable breast cancer: A meta-analysis. Medicine (Baltimore). 97(20):e10634, 2018.
7. Mieog JS, van der Hage JA, van de Velde CJ. Neoadjuvant chemotherapy for operable breast cancer. Br J Surg. 94(10):1189-200, 2007.

Updated 08/09/24