Neoadjuvant Chemo - No Survival Benefit

There is limited long-term data on survival and recurrence with neoadjuvant therapy.

Second, the "research" cited is applicable only to triple negative breast cancer.

Third, there is no evidence of decreased survival/recurrence. All studies to date show equivalence in survival with adjuvant and neo-adjuvant, with only increased local recurrence in neo-adjuvant when surgery is omitted.

Fourth, typically the goal of neoadjuvant therapy is debulking a tumor so that less invasive surgical technique can be used (lumpectomy vs mastectomy).

Fifth, no one claimed improved survival.

It is misleading to post a headline that sounds general (No benefit to this or that) without specifying the subgroup to which it applies (Triple negatives).

Ah yes, and let's not forget that the researchers are UK-based, where there is a well-known bias against neoadjuvant therapy. They simply are not as "up" on the current research and standards of care that we enjoy in the US.

One only has to search "neoadjuvant chemotherapy breast cancer" to find about 10x as many articles showing the benefits of this approach, and quite a few offering data contradicting the article cited here.

And finally, what does this have to do with Alternative, Complementary, and Holistic Treatment?

You should post it on the Triple Negative Forum. That's what it's about.

thanks for the interesting info on neoadjuvent chemo.  I was told at that there was no difference in outcome either way and I was commited to mastectomy even if my tumor was completely gone.  this is the first article I've seen on the subject.  thanks again, tina

Thanks much.. I knew you would know - I've been wondering about why the hold off on using the new knives too.. There are a few other people in the family with other cancers so I appreciate your input!  Best

fightinhard, (love your name by the way)

We talking about early disease only right now....

There is no proof that surgery worked for early disease but there is a very "high chance it does" with clear margin and node removal.  That why I think this needs to be addressed first in research.  Does the patient have active cancer cells after surgery. I feel patients may need chemo after original tx but only if they can see activity.  Until we find out a better way of testing for active cells, we should give lower dose chemo on and off for a year or two just in case instead of bounding a patient upfront who may or may not have disease and destroy their body needlessly for over a year or more.  Now they have a weaken body and immune system and can't fight off the side effects from rads and chemo.  My doctor did feel the way to treat is do chemo, surgery, rads if needed and than stop for four or five months and than do low dose chemo again just in case there are cells trying to move around.

Flalady

What you are saying makes sense.  I was under the impression (probably my own that it all boils down to chemo.  Some it works, some it doesnt, and doing chemo first is a good way to gage that. Seems i may be wrong, which is scary, because i had a great response to chemo, and so did one of my good friends, who is triple neg! (we both had stage 3 pos nodes - nothing after chemo)

FloridaLady, you wrote: ".....Chemo only works if you have active disease..."

That's exactly right. Chemo extends life in those cases. But they've been inflicting chemotherapy indiscriminately on estrogen-positive, early stage women, in total disregard of the evidence.

And anomdenet, thank you for this article. I have been reading extensively about the difference between tumor shinkage and overall survival.

That's the problem with the current orientation of research in America (luckily, things are starting to change in Europe, where they are able to "see the light" faster, because research in those countries is much less dependent on money from the pharmaceutical industry).

I have written somewhere else, and I will never stop repeating: tumor shrinkage and overall survival are 2 completely different matters. Alas..... as soon as a substance is shown shrinking a tumor, the pharmaceutical industry jumps on it to market it immediate (often with studies cut short to save time). Never mind that in reality, the patient will only survive on average 3 months more at the cost of whatever quality of life they could have still enjoyed if they did not have to deal with all those horrendous treatments.

Timothy -

When studies state there was no difference in survival, they mean a survival advantage was not proven statistically at the time the study was stopped.   

I'll give the example for herceptin because I am most familiar with those studies.  The first readouts of the herceptin trials showed large decrease in recurrence, but not a statistically significant increase in survival.  That was because people live for a while after they recur, so it takes awhile to see the effect in survival statistics.  By the second analysis, herceptin did show a statistically demonstrated increase in survival.

Typically, in cancer studies, a decrease in recurrence eventually shows up as a decrease in deaths, it just takes years of follow-up to see.

 Also keep in mind that just because a study does not show a statistically proven advantage, that  doesn't mean that the treatment didn't work, only that it hasn't been proven (perhaps sample size too small or a lot of variability in the data.)  Or it could mean it doesn't work.

Another example: zometa study: demonstrated statistically significant reduced recurrences, and reduced number of cancer deaths, but too soon to prove statistically improved survival.  But based on reduced distant recurrence rate, improved survival will likely show up in the next analysis,