Impact of Sociodemographic Factors on Management of Breast Cancer: Results of QRRO Survey

neoadjuvant hormone therapy (NAHT) versus (vs) those treated with neoadjuvant chemotherapy (NACT) followed by surgery with or without radiation (XRT). Materials/Methods: We reviewed the records of 110 consecutive postmenopausal women treated pre-operatively with either NAHT or NACT from 2004 to 2011. We included subjects with non-metastatic, noninflammatory, ER+ breast cancer and excluded those with Her2neu positive tumors. We compared pathologic complete response (pCR) and breast conserving surgery (BCS) rates as well as long-term rates of local control, distant metastasis free survival (DMFS), and overall survival (OS). Results: Median follow-up time for all patients was 45.7 months. Twentyeight subjects received NAHT, while 82 received NACT. The most commonly prescribed NAHT was an aromatase inhibitor (93%) followed by tamoxifen (7%). Median duration of NAHT was 8.0 months. Fifty-six percent of NACT patients received an anthracycline (A) and taxane-based regimen, while 33% of patients received an A-based regimen alone. Patients receiving NAHT were older than patients receiving NACT (Median age 67 vs 58 years, p < 0.01). There were no significant differences in initial T stage, clinical tumor size, progesterone receptor status, tumor grade, or histology between groups. NACT patients, however, had more advanced N stage compared to NAHT patients (p Z .03). All NAHT patients had residual invasive cancer at the time of surgery, while 7.3% of NACT subjects achieved a pCR (p Z 0.1). Indeed, NACT patients were more likely to develop any pathologic response to treatment (median tumor size decrease of 1.7 cm vs 1.0 cm in NAHT patients, p Z .05), but were less likely to undergo BCS than NAHT subjects (30% vs 68%, p < 0.01). Among BCS patients, 96% of the NACT vs 79% of NAHT patients received post-lumpectomy XRT (p Z .09). Among patients treated with mastectomy, NACT patients were more likely to receive XRT (78% vs 43%, p Z .05). Among all patients, only one patient developed a local recurrence following NAHT and mastectomy without XRT. There was no difference in 4-year DMFS or OS between groups. On multivariate analysis, tumor grade and N stage but not NAHT predicted for poorer OS. Conclusions: Our data suggests that although pCR rates following NAHT in post-menopausal patients with ER+ breast cancer are low, outcomes do not appear to be adversely affected by NAHT treatment in our patient population. NAHT appears to be a viable and potentially less toxic option in select post-menopausal women with ER+ breast cancer. Author Disclosure: D.M. Marcus: None. R. Prabhu: None. R. O’Regan: None. A. Zelnak: None. C. Fasola: None. D. Mister: None. M. Torres: None.