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Invasive disease-free and overall survival after (neo)adjuvant chemotherapy in postmenopausal patients with hormone receptor-positive, HER2-negative early breast cancer treated with upfront letrozole: experiences from the phase IV PreFace trial

Patients with hormone receptor-positive (HRpos), HER2-negative (HER2neg) breast cancer (BC) benefit less from neoadjuvant chemotherapy (NACT) than patients with triple-negative and HER2-positive BC. In this retrospective analysis of the phase IV PreFace clinical trial (NCT01908556), where postmenopa...

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Main Authors: Beierlein, Milena (Author) , Häberle, Lothar (Author) , Nabieva, Naiba (Author) , Maass, Nicolai (Author) , Aktas, Bahriye (Author) , Kümmel, Sherko (Author) , Thomssen, Christoph (Author) , Wolf, Christopher (Author) , Kolberg, Hans-Christian (Author) , Brucker, Cosima (Author) , Janni, Wolfgang (Author) , Dall, Peter (Author) , Schneeweiss, Andreas (Author) , Marmé, Frederik (Author) , Sütterlin, Marc (Author) , Ruebner, Matthias (Author) , Theuser, Anna-Katharin (Author) , Hofmann, Nadine M. (Author) , Böhm, Sybille (Author) , Almstedt, Katrin (Author) , Kellner, Sara (Author) , Gass, Paul (Author) , Lück, Hans-Joachim (Author) , Hein, Alexander (Author) , Schmatloch, Sabine (Author) , Kalder, Matthias (Author) , Uleer, Christoph (Author) , Juhasz-Böss, Ingolf (Author) , Hanf, Volker (Author) , Jackisch, Christian (Author) , Müller, Volkmar (Author) , Rack, Brigitte (Author) , Belleville, Erik (Author) , Wallwiener, Diethelm (Author) , Rody, Achim (Author) , Rauh, Claudia (Author) , Bayer, Chistian M. (Author) , Uhrig, Sabrina (Author) , Huebner, Hanna (Author) , Goossens, Chloë (Author) , Brucker, Sara (Author) , Hack, Carolin C. (Author) , Fehm, Tanja (Author) , Fasching, Peter Andreas (Author)
Format: Article (Journal)
Language:English
Published: 2025
In: International journal of cancer
Year: 2025, Volume: 157, Issue: 11, Pages: 2363-2373
ISSN:1097-0215
DOI:10.1002/ijc.70037
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ijc.70037
Verlag, kostenfrei, Volltext: http://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.70037
Resolving-System, kostenfrei: https://doi.org/10.25673/120877
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Author Notes:Milena Beierlein, Lothar Häberle, Naiba Nabieva, Nicolai Maass, Bahriye Aktas, Sherko Kümmel, Christoph Thomssen, Christopher Wolf, Hans-Christian Kolberg, Cosima Brucker, Wolfgang Janni, Peter Dall, Andreas Schneeweiss, Frederik Marme, Marc W. Sütterlin, Matthias Ruebner, Anna-Katharin Theuser, Nadine M. Hofmann, Sybille Böhm, Katrin Almstedt, Sara Kellner, Paul Gass, Hans-Joachim Lück, Alexander Hein, Sabine Schmatloch, Matthias Kalder, Christoph Uleer, Ingolf Juhasz-Böss, Volker Hanf, Christian Jackisch, Volkmar Müller, Brigitte Rack, Erik Belleville, Diethelm Wallwiener, Achim Rody, Claudia Rauh, Chistian M. Bayer, Sabrina Uhrig, Hanna Huebner, Chloë Goossens, Sara Y. Brucker, Carolin C. Hack, Tanja N. Fehm, Peter A. Fasching
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Summary:Patients with hormone receptor-positive (HRpos), HER2-negative (HER2neg) breast cancer (BC) benefit less from neoadjuvant chemotherapy (NACT) than patients with triple-negative and HER2-positive BC. In this retrospective analysis of the phase IV PreFace clinical trial (NCT01908556), where postmenopausal HRpos BC patients (n = 3297) were treated with 5-year upfront adjuvant letrozole therapy, we evaluated the prognosis of patients treated with adjuvant versus neoadjuvant chemotherapy in HRpos/HER2neg early-stage BC. HRpos/HER2neg patients with information on (neo)adjuvant chemotherapy (n = 2895) were retrospectively selected from all patients enrolled in the PreFace trial. Invasive disease-free survival (iDFS) and overall survival (OS) were compared between patient groups that were treated with neoadjuvant or adjuvant chemotherapy. Chemotherapy was given to 1051 patients (36.3% of all patients), of which 874 (83.2%) received adjuvant chemotherapy and 177 (16.8%) NACT. Pathologic complete response (pCR) rate in the NACT group was 6.9%. Patients treated with NACT had a worse outcome than those treated with adjuvant chemotherapy (5-year iDFS rate 81% vs. 88%; 5-year OS rate 89% vs. 93%). This effect was maintained after adjusting for age, BMI, lymph node status, grading, tumor size, and histology (hazard ratio for iDFS: 1.95 (95%CI: 1.28-2.95); hazard ratio for OS: 2.13 (95%CI: 1.24-3.66)). Further adjustment for taxane-based regimes did not alter results. In conclusion, in this retrospective analysis of patients with early-stage HRpos/HER2neg BC, patients with NACT had a more unfavorable prognosis than patients treated adjuvantly, independent of patient and tumor characteristics. Prognosis of neoadjuvant patients might be affected by resistance mechanisms, warranting further investigation.
Item Description:Erstmals veröffentlicht: 11. Juli 2025
Gesehen am 28.08.2025
Physical Description:Online Resource
ISSN:1097-0215
DOI:10.1002/ijc.70037

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