ORIGINAL VERSION

Neoadjuvant Chemotherapy Survival Rates

            Research data related to breast cancer and its various treatments has led to progress in understanding its prognosis. These different treatments are widely accepted and allows patients to have options. Offering patients, a treatment choice has become a tailored approach. Specifically, neoadjuvant chemotherapy is a type of treatment that shrinks the tumor before the operation. The widely used provisions are chemotherapy and toxic drugs. In most recent years, there has been a growing interest in neoadjuvant chemotherapy because it offers several advantages. Neoadjuvant therapy has become a fundamental treatment for patients with early breast cancer. Neoadjuvant chemotherapy has become an attempt to improve survival rates.

Neoadjuvant chemotherapy can be used to shrink the tumor in order to be reduced for surgery. It has become a vital part in treatment for patients with early stage breast cancer. Chemotherapy drugs including anthracycline and taxane are used in this treatment. Early breast cancer patients may have an advantage with beginning neoadjuvant treatment before surgery.

There isn’t significant evidence for overall survival rates for neoadjuvant chemotherapy versus other treatments. However, neoadjuvant chemotherapy has many advantages of determining and utilizing treatment response prior to surgery for patients. It provides an opportunity for early breast cancer patients to improve outcomes. Neoadjuvant chemotherapy is able to provide potential benefits if patients qualify for this treatment before surgery.

During my research, I found numerous research articles that were unbiased towards neoadjuvant chemotherapy. However, most of their positions and trials were moderate or lacked evidence on the survival rates. Article 1 presents a moderate opinion on neoadjuvant chemotherapy as a way to treat younger women for overall survival rate. Article states, “A trend for improved overall survival was noted in the NSABP-18 study in women aged younger than 50 years treated with NAC compared with adjuvant chemotherapy…”. Certainly, there is a trend for the overall improvements of neoadjuvant therapy among early breast cancer treatment. Articles 1 and 2 portray this middling support on the survival rate for neoadjuvant chemotherapy. The connection between Articles 1 and 2 is their lack of evidence in supporting the survival rates. If more trials were to be conducted, this would help their assertions become more firm and strong. Both articles clear their standpoint but limited themselves in proving their perspective. It might be viewed as a setback and also a pattern where trying to prove the survival rates is nearly impossible. As of right now, there is insufficient data to advocate neoadjuvant chemotherapy improving survival rates.

In recent studies, association between pCR and neoadjuvant chemotherapy have been examined to improve survival rates. pCR, known as pathological complete response is when no active cells are present after the course of neoadjuvant chemotherapy. Article 2 states, “Neoadjuvant chemotherapy is part of the overall treatment of breast cancer and can increase long-term survival among patients who show pCR; pCR has therefore become a critical indicator for both the curative effect of NAC and also prognosis”. It’s important to note that this study consisted of a small sample size and short follow- up time compared to other trials. Although this is a limitation for their findings, an analysis of improved prognosis of neoadjuvant therapy was involved with pCR. Articles 2 and 4 provide this unique relationship between pCR and neoadjuvant chemotherapy. They initiate the strong relationship between neoadjuvant chemotherapy and pCR in order to prove the survival rates. They both chose a different direction by including the significance of pCR after treatment. this might be the missing component for my previous article.  Their study and findings are more focal, leading them to have a better chance at indicating the survival rates.

During my findings, I did find biased attitudes toward neoadjuvant chemotherapy. Article 3 exemplifies a clear stance on opposing this course of treatment. Article 3 states, “If the main objective of neoadjuvant chemotherapy is to increase survival, then these patients with an outstanding baseline prognosis should be spared the toxic side-effects of chemotherapy and undergo surgical removal of their tumors”. This research introduces a conflict of interest on neoadjuvant and its relationship with survival rates. Both previous articles support neoadjuvant as an acceptable method to improve survival rates with insufficient evidence. However, for this article the research goes into depth of the type of drugs that are used. Specifically, taxane and anthracycline are the most widely used for neoadjuvant chemotherapy regimen. This has led them to the belief that these drugs are highly toxic and patients shouldn’t be moving forward with this type of therapy. Certainly, every treatment has its pros and cons but it’s important to note that neoadjuvant chemotherapy is widely known to improve survival; therefore, this led to their dissatisfaction towards the drugs used. Article 1 states, “Clinical trials for new drugs and novel combinations increasingly exploit neoadjuvant use and will be key to improving treatment of patient subgroups”. Articles 1 and 3 provide a pro and con attitude towards neoadjuvant chemotherapy. Article 3 provides a very strong opinion supported with facts opposing the drugs used while Article 1 suggests ways to improve these rates through the use of drug studies but don’t actually go into depth. It’s important to acknowledge the criticism from Article 3 because it provides a different standpoint and things to consider regarding neoadjuvant chemotherapy, creating a larger discussion. Article 3 is evidently opposed of neoadjuvant chemotherapy survival rates and provided valid assertions.

Article 4 focuses on the study of triple negative breast cancer, responding to chemotherapy. Patients who received pCR after neoadjuvant therapy had superior survival outcomes compared with the other patients in the study. Superior overall survival was seen with Stage II disease who experienced pCR following neoadjuvant therapy. According to their results, an observation of overall survival benefit among the patients received neoadjuvant therapy versus pCR. A great connection to consider is between Articles 2 and 4 regarding pCR and neoadjuvant chemotherapy association. While Article 4 creates a stronger argument, both findings from the articles can create a firm favor of neoadjuvant chemotherapy improving survival rates. The articles both evaluate the vital part of enhancing pCR after neoadjuvant therapy treatment. Their specific direction has led them to concentrate in pCR impact on neoadjuvant chemotherapy survival rates. Ultimately, both studies define the survival rates by initiating pCR after neoadjuvant chemotherapy.

Article 5 also focuses on triple negative breast cancer through the use of neoadjuvant chemotherapy and pCR. According to their research, the overall survival rates after neoadjuvant chemotherapy was 97.4% between 2-10 years. This is a significant number to recognize because it depicts the survival rate of a patient’s life. The article states, “The pathological complete response is consistent with that reported in other studies involving neoadjuvant chemotherapy of TNBC…” Their study demonstrated the impact pCR has on neoadjuvant chemotherapy. Articles 4 and 5 create this pattern of using pCR in order to provide the best survival rate for patients. These articles provide the possibility neoadjuvant chemotherapy can have on improving survival rates incorporating the use of pCR. The pattern between Articles 4 and 5 is very clear by now. The most significant way to improve the survival rates is by including the use of pCR because it provides the most accurate data.

As of right now, there are biased and unbiased viewpoints toward neoadjuvant chemotherapy. The main controversy of the improved survival rates in neoadjuvant chemotherapy is that there isn’t sufficient evidence to interpret this claim and the articles acknowledge that. Furthermore, this represents Article 1 and 2, they indicated their position but their data was inadequate. However, I viewed their studies as the starting point of analyzing the survival rates. Both articles also had limitations due to the conduction of the study and its results. It’s clear that there isn’t enough evidence to support the survival rates through the process of neoadjuvant chemotherapy solely.

It’s important to acknowledge the pattern of these studies because they can be portrayed as controversial. A few of the articles state their opinion but the trials are not enough to support their claims while the others included other key components in order to create a strong argument, ultimately leading to valid data. Moving forward, research articles focusing on the improved survival rates, should plan accordingly for their studies to impact and depict their position.          Additionally, I believe research studies should focus on the survival rate by evaluating a certain percentage of people who live beyond 5 years after their diagnosis. If the studies are growing and consistent, the improved survival rates will have sustained evidence. This would create a significant impact and change for patients. It would provide valuable information for health providers and physicians’ to use in order to help a patient’s treatment.

As a student, it was important for me to pick different opinions and data from research articles. It helped me gain more knowledge and also view the underlying issue. I was able to provide different standpoints on this controversial topic. While I chose articles that were in favor of neoadjuvant chemotherapy improving survival rates, they created insufficient data to rely on. Furthermore, I also focused on strong research between the association of pCR and neoadjuvant chemotherapy. Their data was very convincing and portrayed the improved survival rates. Neoadjuvant chemotherapy is on the verge on improving survival rates.

 

Works Cited

Cain, H., Machpherson, I.R., Beresford, M., Pinder, S., Pong, J., Dixon, J.M. “Neoadjuvant          chemotherapy in early breast cancer: treatment considerations and common debates in         practice.” Clinical Oncology 29(2017):642-652.Print.

Zhang, W., Tian, H., Yang, S. “The efficacy of neoadjuvant chemotherapy for HER-2-positive       locally advanced breast cancer and survival analysis”. Analytical Cellular Pathology         2017(2017):1-5. Print.

Prat, A., Fan, C., Fernandez, A., Hoadley, K., Martinello, R., Vidal, M., Viladot, M., Pineda, E.,       Arance, A., Munoz, M., Montserrat, Pana, L., Cheang, M., Adamo, B., Perou, C.      “Response and survival of breast cancer intristic subtypes following multi-agent neoadjuvant chemotherapy”. BMC Medicine (2015):Print.

Biswas, T., Efird, J., Prasad, S., Jindal, C., Walker, P. “The survival benefit of neoadjuvant            chemotherapy and pCR among patients with advanced stage triple negative breast           cancer”. Oncotanget 8(2017):112712-112719. Print.

Guiu, S., Arnould, C., Coudert, B., Liegard, M., Mayer, F., Faveier, L., Fumoleau, P. “Neoadjuvant             chemotherapy for triple negative breast cancer: pathologic complete response and   survival after long-term follow up”. Cancer Research 69(2009):10-13. Print.

 

REVISED VERSION

Neoadjuvant Chemotherapy Survival Rates

            Neoadjuvant chemotherapy (NAC) is a type of treatment that shrinks the tumor before the process of surgery. The widely used provisions are chemotherapy and toxic drugs. Chemotherapy drugs including anthracycline and taxane are used in NAC treatment. Recent research studies focusing on NAC treatment improving survival rates have portrayed biased and unbiased viewpoints. Although NAC treatment is promising, more studies should be conducted.

In most recent years, there has been a growing interest in NAC treatment because it offers several advantages. Neoadjuvant chemotherapy has become an attempt to improve survival rates. Most research data entails how targeted and beneficial NAC treatment is for early breast cancer patients.

There isn’t significant evidence for overall survival rates regarding neoadjuvant chemotherapy versus other treatments. However, neoadjuvant chemotherapy has many advantages of utilizing treatment response prior to surgery for patients. It provides an opportunity for early breast cancer patients to improve outcomes. Neoadjuvant chemotherapy is able to provide potential benefits if patients qualify for this treatment before surgery.

During my research, I found numerous research articles that were unbiased towards neoadjuvant chemotherapy. However, most of their positions and trials were moderate or lacked evidence on the survival rates. In a 2017 study, Cain et al ¹ discovered NAC treatment as a way to treat young women. Cain states, “A trend for improved overall survival was noted in the NSABP-18 study in women aged younger than 50 years treated with NAC compared with adjuvant chemotherapy…”¹ The researchers were able to study the effectiveness among the young group of the regimens used in NAC treatment. Certainly, there is a trend and advantage for the overall improvements of neoadjuvant therapy among early breast cancer treatment. Cain et al ¹and Zhang et al ² portray this middling support on the survival rate for neoadjuvant chemotherapy. The connection between both of these studies is their lack of evidence in supporting the survival rates. Both articles state their statement but limited themselves in proving their perspective. If more trials were to be conducted, this would help their assertions become more firm and strong. Although Zhang chose a different route by examining the significance of pCR after NAC treatment, this might be the missing component from Cain’s article. It might be viewed as a setback and also a pattern where trying to prove the survival rates is a very technical topic. As of right now, there is insufficient data to advocate neoadjuvant chemotherapy improving survival rates.

In recent studies, association between pCR and neoadjuvant chemotherapy have been examined to improve survival rates. pCR, known as pathological complete response is when no active cells are present after the course of neoadjuvant chemotherapy. In a 2017 study, Zhang et al ² discovered the correlation between NAC and pCR treatment. It’s important to note that this study consisted of a small sample size and short follow- up time compared to other trials. Although this is a limitation for their findings, an analysis of improved prognosis of neoadjuvant therapy was involved with pCR. Zhang states, “Neoadjuvant chemotherapy is part of the overall treatment of breast cancer and can increase long-term survival among patients who show pCR; pCR has therefore become a critical indicator for both the curative effect of NAC and also prognosis”.² This quote exemplifies the significance pCR has on NAC survival rates. It’s a development that more researchers have been conducting in their study. In a relatable study, Biswas et al ⁴ and Zhang et al ² provide this unique relationship between pCR and neoadjuvant chemotherapy. They initiate the strong relationship between NAC and pCR in order to demonstrate the survival rates. Although both articles included a component to enhance NAC treatment, the researchers were unable to conclude on the overall survival rate. Overall, Zhang’s study and findings are more focal, leading them to have a better chance at indicating the survival rates through multiple studies.

During my findings, I did find biased attitudes toward neoadjuvant chemotherapy. A 2015 study, Prat et al ³ exemplifies a clear stance on opposing this course of treatment. Prat states, “If the main objective of neoadjuvant chemotherapy is to increase survival, then these patients with an outstanding baseline prognosis should be spared the toxic side-effects of chemotherapy and undergo surgical removal of their tumors”.³ This research introduces a hard line against NAC and its relationship with survival rates. The previous articles describe neoadjuvant as an acceptable method to improve survival rates with insufficient evidence and middling support. However, for this article the research goes into depth of the type of drugs that are used. From their research, they were able to conclude that the chemotherapy drugs are very toxic and suggest patients shouldn’t be moving forward with this type of therapy. Certainly, every treatment has its pros and cons but Prat’s research supports their dissatisfaction towards the regiments used by valid assertions and data. From my previous article, Cain et al ¹ states, “Clinical trials for new drugs and novel combinations increasingly exploit neoadjuvant use and will be key to improving treatment of patient subgroups”.¹ Cain and Prat provide a positive and negative attitude towards neoadjuvant chemotherapy. Prat provides a very strong opinion supported with valid research data opposing the drugs used, while Cain suggests ways to improve these rates through the use of drug studies but doesn’t actually go into depth. It’s important to acknowledge the criticism from Prat’s study because it provides a different standpoint and things to consider regarding neoadjuvant chemotherapy, creating a larger discussion. Prat et al research data is evidently opposed of neoadjuvant chemotherapy survival rates and provided valid assertions.

A 2017 study, Biswas et al ⁴ focuses on the study of triple negative breast cancer, responding to chemotherapy. Patients who received pCR after neoadjuvant therapy had superior survival outcomes compared with the other patients in the study. Superior overall survival was seen with Stage II disease who experienced pCR following neoadjuvant therapy. According to their results, an observation of overall survival benefit among the patients received neoadjuvant therapy versus pCR. A great connection to consider is between Zhang et al ² and Biswas et al ⁴ regarding pCR and neoadjuvant chemotherapy association. While Biswas creates a stronger argument, both findings from the articles can create a firm favor of neoadjuvant chemotherapy improving survival rates. The studies both evaluate the vital part of enhancing pCR after neoadjuvant therapy treatment. Their specific direction has led them to concentrate on pCR impact on neoadjuvant chemotherapy survival rates. Ultimately, both studies define the survival rates by initiating pCR after neoadjuvant chemotherapy.

In a 2009 study, Guiu et al ⁵ also focuses on triple negative breast cancer through the use of neoadjuvant chemotherapy and pCR. According to their research, the overall survival rates after neoadjuvant chemotherapy was 97.4% between 2-10 years. This is a significant number to acknowledge because it depicts the survival rate of a patient’s life. Guiu states, “The pathological complete response is consistent with that reported in other studies involving neoadjuvant chemotherapy of TNBC…”⁵. Their study demonstrated the impact pCR has on neoadjuvant chemotherapy. Biswas et al ⁴ and Guiu et al ⁵ create this pattern of using pCR in order to provide the best survival rate for patients. These articles provide the possibility neoadjuvant chemotherapy can have on improving survival rates incorporating the use of pCR. The array between both of these studies is very clear by now. The most significant way to improve the survival rates is by including the use of pCR because it has been shown to provide the most accurate data. pCR, an indicator for patient’s prognosis, has been shown to help boost the survival rate through both of these studies. Although Biswas and Guiu were not able to conclude on the overall survival, they are both valid research data models that could possibly prove this emerging topic.

The main controversy of the improved survival rates in neoadjuvant chemotherapy is that there isn’t sufficient evidence to interpret this claim and the articles acknowledge that. Furthermore, this represents Cain et al ¹ and Zhang et al ², they indicated their position but their data was inadequate. However, I viewed their studies as the starting point of analyzing the survival rates. Both articles also had limitations due to the conduction of the study and its results. It’s clear that there isn’t enough evidence to support the survival rates through the process of neoadjuvant chemotherapy solely. While Biswas et al ⁴ and Guiu et al ⁵ provided very strong data in order to prove their viewpoint. They both emphasized on the importance of including a key factor, pCR in order to help benefit patients’ overall survival rate.

It’s important to acknowledge the pattern of these studies because they can be portrayed as controversial. A few of the articles state their opinion but the trials are not enough to support their claims while the others included other key components in order to create a strong argument, ultimately leading to valid data. Moving forward, research articles focusing on the improved survival rates, should plan accordingly for their studies to impact and depict their position.          Additionally, I believe research studies should focus on the survival rate by evaluating a certain percentage of people who live beyond 5 years after their diagnosis. If the studies are growing and consistent, the improved survival rates will have sustained evidence. This would create a significant impact and change for patients. It would provide valuable information for health providers and physicians’ to use in order to help a patient’s prognosis.

As a student, it was important for me to pick different opinions and data from research articles. It helped me gain more knowledge and also view the underlying issue. I was able to provide different standpoints on this controversial topic. While I chose articles that were in favor of neoadjuvant chemotherapy improving survival rates, they created insufficient data to rely on. Furthermore, I also focused on strong research between the association of pCR and neoadjuvant chemotherapy. Their data was very convincing and portrayed the improved survival rates. Neoadjuvant chemotherapy is on the verge on improving survival rates.

Works Cited

1. Cain, H., Machpherson, I.R., Beresford, M., Pinder, S., Pong, J., Dixon, J.M. Neoadjuvant    chemotherapy in early breast cancer: treatment considerations and   common debates in practice. Clinical Oncology (2017);642-652.
2. Zhang, W., Tian, H., Yang, S. The efficacy of neoadjuvant chemotherapy for HER-2- positive locally advanced breast cancer and survival analysis. Analytical Cellular Pathology (2017);1-5.
3. Prat, A., Fan, C., Fernandez, A., Hoadley, K., Martinello, R., Vidal, M., Viladot, M., Pineda, , Arance, A., Munoz, M., Montserrat, Pana, L., Cheang, M., Adamo, B., Perou, C.    Response and survival of breast cancer intristic subtypes following multi-agent   neoadjuvant chemotherapy. BMC Medicine (2015).
4. Biswas, T., Efird, J., Prasad, S., Jindal, C., Walker, P. The survival benefit of neoadjuvant chemotherapy and pCR among patients with advanced stage triple negative breast Oncotanget (2017);112712-112719. Print.
5. Guiu, S., Arnould, C., Coudert, B., Liegard, M., Mayer, F., Faveier, L., Fumoleau, P. Neoadjuvant   chemotherapy for triple negative breast cancer: pathologic       complete response and survival after long-term follow up. Cancer Research (2009);10-13.