Screening and exploration of neoadjuvant "de-escalation" therapy for early breast cancer

Nana Zhang ^1* Ming Shan ¹ Zhenfeng Huang ¹ Fei Gao ² Bingqi Xu ¹ Wenli Kang ³ Jian Zhang ⁴ Li Song ⁵ Jun Liu ⁶ Jiawei Zhang ⁵ Mingyang Liu ⁷ Haitao Jiang ⁸ Xinhang Liu ⁹ Zibo Shen ¹⁰ Peng Zhang ¹¹ Abiyasi Nanding ¹ Guoqiang Zhang ^1*

• ¹ Harbin Medical University Cancer Hospital, Harbin, China
• ² Heilongjiang General Hospital of Daqing Oil Field, Daqing, China
• ³ Beidahuang Group General Hospital, Harbin, China
• ⁴ Third Affiliated Hospital, Shenzhen University, Shenzhen, China
• ⁵ Jiamusi Tumor Hospital, Jiamusi, Heilongjiang Province, China
• ⁶ Dalian Municipal Friendship Hospital, Dalian, Liaoning Province, China
• ⁷ WangKui County People’s hospital, Suihua, China
• ⁸ Hailun people's Hospital, Hailun, China
• ⁹ First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
• ¹⁰ King‘s College London, London, United Kingdom
• ¹¹ Baotou Teachers' College, Baotou, China

Background: Neoadjuvant therapy for breast cancer improves the prognosis of high-risk patients. However, whether pathological completed response (pCR) can be used as a surrogate endpoint for de-escalation therapy in patients who are relatively sensitive to treatment remains to be elucidated.Methods：We retrospectively reviewed 143 breast cancer patients, with clinical stage (cStage) II-IIIA who received neoadjuvant chemotherapy and achieved pCR in a short time (within 16 weeks) from 2012 to 2022. The prognosis of patients was analysed using the Kaplan-Meier method, Cox proportional hazards regression models to identify independent clinicopathologic factors affecting prognosis.The median follow-up period was 47 months, the overall 4-year disease-free survival (DFS) and overall survival (OS) were 95.3% and 96.9%, respectively, in 143 patients with pCR after neoadjuvant chemotherapy. The 4-year DFS between the postoperative adjuvant chemotherapy and no adjuvant chemotherapy groups was 76.4% and 95.2%, with a significant statistical difference between both groups (P < 0.05). For HER2-positive (HER2+) and Triple negative breast cancer(TNBC), the addition of targeted therapy or platinum-based drugs had no impact on prognosis.Univariate and multivariate analyses of prognosis showed that only postoperative adjuvant chemotherapy significantly affected prognosis.Patients with operable cStage II-IIIA breast cancer who achieved pCR after a short period of neoadjuvant chemotherapy have a satisfactory prognosis and may be suitable for chemotherapy "de-escalation." This approach is also a dominant application of neoadjuvant "tailoring therapy."