Neoadjuvant chemotherapy is commonly used in stage III breast cancer for disease down-staging. Its use has now been extended to early breast cancer to increase the rate of breast-conserving surgery. This study aimed to evaluate the effectiveness of neoadjuvant chemotherapy in early operable cancers. A retrospective study was carried out at the Hong Kong Sanatorium & Hospital of 102 patients with stage I to III primary breast cancer. All patients who underwent neoadjuvant chemotherapy followed by definitive breast surgery between January 2004 and July 2013 were included. Their pathological complete response and rate of breast-conserving surgery were studied. Data were compared using Chi squared test and Student's t test. After neoadjuvant chemotherapy, 23% of patients achieved a pathological complete response, of whom 80% had human epidermal growth factor receptor 2 (HER2)-positive disease or triple-negative disease. Hormonal receptor negativity was associated with a higher pathological complete response rate (P<0.05) that was in turn associated with a higher likelihood of breast-conserving surgery (P=0.028). Patients with stage II disease were more likely to convert from mastectomy to breast-conserving surgery following neoadjuvant chemotherapy. Neoadjuvant chemotherapy is a useful treatment to downsize tumour in early breast cancer, thereby increasing the rate of breast-conserving surgery. It is especially effective in patients with HER2-positive/oestrogen receptor-negative disease or triple-negative disease.

The Oncotype DX Breast Cancer Assay is validated to assess risk of distant recurrence and likelihood of chemotherapy (CT) benefit in estrogen receptor-positive ESBC in various populations. In Hong Kong, > 80% of breast cancers are early stage breast cancer (ESBC) and > 60% of these women receive CT. This prospective study measured changes in CT type and recommendations, as well as physician impression of assay impact in a homogenous Chinese population. Consecutive patients with estrogen receptor-positive, T1-3 N0-1mi M0 ESBC were offered enrollment. After surgery, physicians discussed treatment options with patients, then ordered the assay, then reassessed treatment recommendation considering assay results. Changes in treatment recommendation, CT utilization, physician confidence, and physician rating of influence on their treatment recommendations were measured. A total of 146 evaluable patients received pre- and post-testing treatment recommendations. CT recommendations (including changes in intensity of CT) were changed for 34 of 146 patients (23.3%; 95% confidence interval, 16.7%-31.0%); change in intensity occurred in 7 of 146 (4.8%). There were 27 changes in treatment recommendations of adding or removing CT altogether (18.5% change; 95% confidence interval, 12.6%-25.8%). CT recommendations decreased from 52.1% to 37.7%, a net absolute reduction of 14.4% (P < .001; 27.6% net relative reduction). Pre-assay, 96% of physicians agreed/strongly agreed that they were confident in their treatment recommendation; post-assay, 90% of physicians agreed/strongly agreed with the same statement. Thirty percent of physicians agreed/strongly agreed that the test had influenced their recommendation, similar to the proportion of changed recommendations. The Oncotype DX Assay appears to influence physician ESBC adjuvant treatment recommendations in Hong Kong.

Background: Although invasive lobular carcinoma (ILC) of the breast differs from invasive ductal carcinoma (IDC) in numerous respects - including its genetics, clinical phenotype, metastatic pattern, and chemosensitivity - most experts continue to manage ILC and IDC identically in the adjuvant setting. Here we address this discrepancy by comparing early-stage ILC and IDC in two breast cancer patient cohorts of differing nationality and ethnicity. Methods: The clinicopathologic features of 2029 consecutive breast cancer patients diagnosed in Hong Kong (HK) and Australia (AUS) were compared. Interrelationships between tumor histology and other clinicopathologic variables, including ER/PR and Ki67, were analysed. Results: Two hundred thirty-nine patients were identified with ILC (11.8%) and 1790 patients with IDC. AUS patients were older (p <0.001) and more often postmenopausal (p <0.03) than HK patients. As expected, ILC tumors were lower in grade and proliferative rate, and more often ER-positive and HER2-negative, than IDC (p 0.7). Moreover, whereas IDC tumors exhibited a strongly negative relationship between ER/PR and Ki67 status (p 0.6). Conclusion: These data imply that the primary adhesion defect in ILC underlies a secondary stromal-epithelial disconnect between hormonal signaling and tumor growth, suggesting in turn that this peritumoral feedback defect could reduce both the antimetastatic (adjuvant) and tumorilytic (palliative) efficacy of cytotoxic therapies for such tumors. Hence, we caution against assuming similar adjuvant chemotherapeutic survival benefits for ILC and IDC tumors with similar ER and Ki67, whether based on immunohistochemical or gene expression assays.