Implementation of neoadjuvant chemotherapy for breast cancer in HKUSZH: A real-world setting with Multiple Disciplinary Team

Abstract

Background: The use of neoadjuvant chemotherapy is increasing in China but little has been reported. The current retrospective study aimed to evaluate the real-world implementation of neoadjuvant chemotherapy in Academic-based Southern China Hospital where regular MDT is in place. Methods: Review of MDT records from July 2014 to July 2017 were performed. Final analysis included patients with locoregionally-advanced invasive breast cancer who were offered neoadjuvant at MDT. Compliance to MDT decision, scheduled treatment and clinical outcomes were described. Result: Sixty-six female patients were included for analysis. The median age was 45 (range 31–66). Most of the patients were married (95.5%) and well-educated (secondary school or higher: 83.3%). The mean tumor size was 3.86 cm (range: 0.8–9.0 cm). The decision to receive neoadjuvant chemotherapy was mostly made jointly by the patients and their families (56.1%). The compliance to MDT decision was high (92.4%). Five patients refused neoadjuvant chemotherapy due to worry about delaying surgery or toxicity of chemotherapy. Fifty-two patients (78.8%) completed all curative treatment. Of the 9 patients who did not complete the planned neoadjuvant chemotherapy, 4 were due to suboptimal clinical response, 3 due to treatment-related toxicity and 2 due to patient preference. The PR+CR rate was 86.9% and pCR rate was 19.7%. After a median follow-up of 24.8 months, 4 patients relapsed and one of them died. Conclusions: Implementation of neoadjuvant chemotherapy was feasible with high compliance rate and good efficacy in a MDT setting. Understanding of the decision-making process and reasons for default also improve patient compliance.