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National trends in neoadjuvant chemotherapy utilization in patients with early-stage node-negative triple-negative breast cancer: the impact of the CREATE-X trial

  • Epidemiology
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Abstract

Purpose

Neoadjuvant chemotherapy (NAC) for triple-negative breast cancer (TNBC) allows for assessment of tumor pathological response and has survival implications. In 2017, the CREATE-X trial demonstrated survival benefit with adjuvant capecitabine in patients TNBC and residual disease after NAC. We aimed to assess national rates of NAC for cT1–2N0M0 TNBC before and after CREATE-X and examine factors associated with receiving NAC vs adjuvant chemotherapy (AC).

Methods

A retrospective cohort study of women with cT1-2N0M0 TNBC diagnosed from 2014 to 2019 in the National Cancer Database (NCDB) was performed. Variables were analyzed via ANOVA, Chi-squared, Fisher Exact tests, and a multivariate linear regression model was created.

Results

55,633 women were included: 26.9% received NAC, 52.4% AC, and 20.7% received no chemotherapy (median ages 53, 59, and 71 years, p < 0.01). NAC utilization significantly increased over time: 19.5% in 2014–15 (n = 3,465 of 17,777), 27.1% in 2016–17 (n = 5,140 of 18,985), and 33.6% in 2018–19 (n = 6,337 of 18,871, p < 0.001). On multivariate analysis, increased NAC was associated with younger age (< 50), non-Hispanic white race/ethnicity, lack of comorbidities, cT2 tumors, care at an academic or integrated-network cancer program, and diagnosis post-2017 (p < 0.05 for all). Patients with government-provided insurance were less likely to receive NAC (p < 0.01). Women who traveled > 60 miles for treatment were more likely to receive NAC (p < 0.01).

Conclusion

From 2014 to 2019, NAC utilization increased for patients with cT1–2N0M0 TNBC. Racial, socioeconomic, and access disparities were observed in who received NAC vs AC and warrants interventions to ensure equitable care.

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Data availability

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Funding

CSC is supported by the National Institutes of Health (NIH) under Award Number 1K08CA276706-01A1 (PI: Cortina). The content of this manuscript is soley the responsiblity of the authors and does not neccessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA

    Christine Rogers, Adrienne N. Cobb, Morgan K. Johnson, Amanda L. Kong & Chandler S. Cortina

  2. Zibler School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI, USA

    Jan I. C. Lloren & Chiang-Ching Huang

  3. Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Lubna N. Chaudhary

  4. Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA

    Lubna N. Chaudhary, Amanda L. Kong & Chandler S. Cortina

  5. University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mediget Teshome & Puneet Singh

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  1. Christine Rogers
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Rogers, C., Cobb, A.N., Lloren, J.I.C. et al. National trends in neoadjuvant chemotherapy utilization in patients with early-stage node-negative triple-negative breast cancer: the impact of the CREATE-X trial. Breast Cancer Res Treat 203, 317–328 (2024). https://doi.org/10.1007/s10549-023-07114-8

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