New Study in JNCCN Calls for Continued Aggressive Treatment for Breast Cancer in Women Under 40

In In The News by Barbara Jacoby

By focusing on younger women with breast cancer, researchers were able to shed new light on the risks presented by residual disease for this population, regardless of affected site

A new study from the Stanford Cancer Institute finds that young women who are treated with chemotherapy for breast cancer but have residual tumor in either the breast or lymph nodes have higher chances of recurrence compared to those with no evidence of any residual invasive tumor (pathologic complete response). The findings were published in the July issue of JNCCN – Journal of the National Comprehensive Cancer Network. The research was led by Margaret Kozak, MD, Resident, and Kathleen C. Horst, MD, Associate Professor of Radiation Oncology, both at the Stanford University School of Medicine, and took a close look at the outcomes for women who were diagnosed with breast cancer under the age of 40.

“Young women with breast cancer tend to present with more advanced disease and with more aggressive breast cancer subtypes, such as triple negative, so it is important not to group them in with older women who are more likely to be diagnosed with slower-growing breast tumors,” explained Dr. Kozak. “This is a particularly high-risk group that is not studied on its own in prospective clinical trials, so few details exist on the optimal approach to treatment for this patient population.“

The retrospective analysis was conducted on 155 women who were treated at Stanford between 1991 and 2015. Their median age was 36 years, with a median follow-up time of 52 months. Patients were excluded from the study if their records were not available, if they had metastatic disease at the time of diagnosis, or if they had received chemotherapy for other cancer diagnoses. The researchers found that patients who received neoadjuvant chemotherapy and were left with residual disease in either the breast or lymph nodes had a significantly higher incidence of local, regional, or distant failure, compared to patients who achieved pathologic complete response (see: Figure 1Figure 2).

“This is important because an ongoing question right now is whether de-escalation of treatment in the form of omitting adjuvant radiation treatment is appropriate for patients who attain lymph node negative status after neoadjuvant chemotherapy,” said Dr. Horst. “Women under 40 with breast cancer should continue to be treated aggressively; de-escalation of treatment should only be considered for those with a complete response to chemotherapy or within the context of a clinical trial.”

“By assessing patient outcomes in a relatively large group of women under 40 treated with neoadjuvant chemotherapy, this study adds significantly to the existing literature,” said Meena S. Moran, MD, Professor and Director of Yale Radiation Therapy Breast Program, Yale Cancer Center/Smilow Cancer Hospital, Member, NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Breast Cancer. “The findings highlight the aggressive nature of this disease in young patients when a complete pathologic response is not achieved in both lymph nodes and the breast. That was not apparent in the original randomized trials. These results suggest that young patients who don’t achieve a complete response are part of a high risk group. At a minimum, these patients should adhere to standard post-mastectomy or whole breast radiation indications, as described by the NCCN Guidelines® for Breast Cancer – but, due to the high risk nature of their disease, they should also be considered for additional systemic options and enrollment in clinical trials.”

The researchers determined that mastectomy, adjuvant radiation therapy, and achievement of pathologic complete response were all good predictors for overall survival.

To read the entire study, visit Complimentary access to “Outcomes Following Neoadjuvant Chemotherapy for Breast Cancer in Women Aged 40 Years and Younger: Impact of Pathologic Nodal Response” is available until September 10, 2018.

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About JNCCN—Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit To inquire if you are eligible for a FREE subscription to JNCCN, visit Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.

The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

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