The NeST (Neoadjuvant systemic therapy in breast cancer) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making
Irwin, G. W.
Coles, C. E.
Cutress, R. I.
Dave, R. V.
Gardiner, M. D.
O'Brien, Ciara S
O'Connell, R. L.
Shaaban, A. M.
Singh, J. K.
McIntosh, S. A.
AffiliationRoyal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool, L7 8XP, UK.
MetadataShow full item record
AbstractBackground: Neoadjuvant systemic therapy (NST) is increasingly used in the treatment of breast cancer, yet it is clear that there is significant geographical variation in its use in the UK. This study aimed to examine stated practice across UK breast units, in terms of indications for use, radiological monitoring, pathological reporting of treatment response, and post-treatment surgical management. Methods: Multidisciplinary teams (MDTs) from all UK breast units were invited to participate in the NeST study. A detailed questionnaire assessing current stated practice was distributed to all participating units in December 2017 and data collated securely usingREDCap. Descriptive statistics were calculated for each questionnaire item. Results: Thirty-nine MDTs from a diverse range of hospitals responded. All MDTs routinely offered neoadjuvant chemotherapy (NACT) to a median of 10% (range 5-60%) of patients. Neoadjuvant endocrine therapy (NET) was offered to a median of 4% (range 0-25%) of patients by 66% of MDTs. The principal indication given for use of neoadjuvant therapy was for surgical downstaging. There was no consensus on methods of radiological monitoring of response, and a wide variety of pathological reporting systems were used to assess tumour response. Twenty-five percent of centres reported resecting the original tumour footprint, irrespective of clinical/radiological response. Radiologically negative axillae at diagnosis routinely had post-NACT or post-NET sentinel lymph node biopsy (SLNB) in 73.0 and 84% of centres respectively, whereas 16% performed SLNB pre-NACT. Positive axillae at diagnosis would receive axillary node clearance at 60% of centres, regardless of response to NACT. Discussion: There is wide variation in the stated use of neoadjuvant systemic therapy across the UK, with general low usage of NET. Surgical downstaging remains the most common indication of the use of NAC, although not all centres leverage the benefits of NAC for de-escalating surgery to the breast and/or axilla. There is a need for agreed multidisciplinary guidance for optimising selection and management of patients for NST. These findings will be corroborated in phase II of the NeST study which is a national collaborative prospective audit of NST utilisation and clinical outcomes.
CitationWhitehead I, Irwin GW, Bannon F, Coles CE, Copson E, Cutress RI, et al. The NeST (Neoadjuvant systemic therapy in breast cancer) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making. BMC Cancer. 2021;21(1):90.
- The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: National practice questionnaire of United Kingdom multi-disciplinary decision making.
- Authors: Morgan JL, Cheng V, Barry PA, Copson E, Cutress RI, Dave R, Elsberger B, Fairbrother P, Hartup S, Hogan B, Horgan K, Kirwan CC, McIntosh SA, O'Connell RL, Patani N, Potter S, Rattay T, Sheehan L, Wyld L, Kim B, MARECA study research collaborative
- Issue date: 2022 Jul
- Patterns of axillary staging and management in clinically node positive breast cancer patients treated with neoadjuvant systemic therapy: Results of a survey amongst breast cancer specialists.
- Authors: Simons JM, Maaskant-Braat AJG, Luiten EJT, Leidenius MHK, van Nijnatten TJA, Boelens PG, Koppert LB, van der Pol CC, van de Velde CJH, Audisio RA, Smidt ML
- Issue date: 2020 Jan
- Axillary sentinel lymph node biopsy after neoadjuvant chemotherapy for carcinoma of the breast.
- Authors: Schwartz GF, Tannebaum JE, Jernigan AM, Palazzo JP
- Issue date: 2010 Mar 1
- Refining the Performance of Sentinel Lymph Node Biopsy Post-neoadjuvant Chemotherapy in Patients with Pathologically Proven Pre-treatment Node-positive Breast Cancer: An Update for Clinical Practice.
- Authors: El Hage Chehade H, Headon H, Kasem A, Mokbel K
- Issue date: 2016 Apr
- The NeST (neoadjuvant systemic therapy in breast cancer) study - Protocol for a prospective multi-centre cohort study to assess the current utilization and short-term outcomes of neoadjuvant systemic therapies in breast cancer.
- Authors: Irwin GW, Bannon F, Coles CE, Copson E, Cutress RI, Dave RV, Grayson M, Holcombe C, Irshad S, O'Brien C, O'Connell RL, Palmieri C, Shaaban AM, Sharma N, Singh J, Whitehead I, Potter S, McIntosh SA
- Issue date: 2019