Assessment of circulating tumor cells in breast cancer patients undergoing neoadjuvant chemotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10079-10079 ◽  
Author(s):  
J. B. Smerage ◽  
D. F. Hayes ◽  
G. V. Doyle ◽  
L. W. Terstappen ◽  
M. E. Brown ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Predictive Value ◽  
Residual Disease ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Multiple Time ◽  
The Mean

10079 Background: Circulating tumor cells (CTCs) are a valuable prognostic factor in metastatic breast cancer, suggesting that CTCs, if present, may be clinically useful in other breast cancer (BC) settings. This study prospectively evaluated CTCs before and after neoadjuvant chemotherapy (NACT) in patients with operable breast cancer. Methods: 7.5 or 30ml of blood were drawn in CellSave tubes from 26 Pts about to receive NACT (docetaxel + capecitabine followed by adriamycin + cytoxan) followed by surgery. CTC analysis is being performed at multiple time points. Data presented are from baseline (prior to first dose), post-NACT, and 3 months after surgery. CTCs were measured by immunomagnetic separation and automated fluorescent microscopy using the CellSearch System (Veridex/Immunicon Corp). Results: Baseline CTCs: For the first 11 pts CTCs were analyzed from 7.5ml of blood. 36% (4/11) had ≥1 CTC, 27% (3/11) had ≥2 CTCs. Of pts with detectable CTCs, the mean was 2.75 CTCs/7.5ml (range 1–4). To improve baseline sensitivity, 30ml blood was drawn from the subsequent 15 pts. One sample was not evaluable. 50% (7/14) had ≥1 detectable CTC and 29% (4/14) had ≥2 CTCs. Of pts with detectable CTCs, the mean was 3.0 CTCs/30ml (range 1–10). CTCs post-neoadjuvant therapy: All 26 pts had 30ml of blood drawn for CTC analysis. 27% (7/26) had ≥1 CTC, and 8% (2/26) had ≥2 CTCs. Using as threshold of ≥2 CTCs to define elevated, CTCs post-chemotherapy were compared to the pathologic complete response (pCR). Sensitivity was 10% (2 of 18 pts with residual disease had elevated CTCs). Specificity was 100% (0 of 7 pts with a pCR had elevated CTCs). This correlated to a positive predictive value of 100% and a negative predictive value (NPV) of 28%. CTCs 3 months after surgery: Of 21 pts analyzed, only one pt (5%) had a single CTC. Long-term follow-up blood collection is ongoing. Conclusions: CTCs are detectable in ∼30% locally advanced BC. All patients with CTCs after NACT had residual disease at surgery, and no CTCs were detected in patients with pCR. However, the absence of CTCs after NACT did not predict pCR. Pts will be followed to determine if CTCs correlate with recurrence and survival. [Table: see text]

scholarly journals Neoadjuvant Chemotherapy for Breast Cancer: Past, Present, and Future

2020 ◽  
Vol 14 ◽  
pp. 117822342098037
Author(s):  
Mariko Asaoka ◽  
Shipra Gandhi ◽  
Takashi Ishikawa ◽  
Kazuaki Takabe
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Residual Disease ◽  
Early Stage ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Definitive Surgery ◽  
Individual Drug Response ◽  
The Individual

Neoadjuvant chemotherapy (NAC) had been developed as a systematic approach before definitive surgery for the treatment of locally advanced or inoperable breast cancer such as inflammatory breast cancer in the past. In addition to its impact on surgery, the neoadjuvant setting has a benefit of providing the opportunity to monitor the individual drug response. Currently, the subject of NAC has expanded to include patients with early-stage, operable breast cancer because it is revealed that the achievement of a pathologic complete response (pCR) is associated with excellent long-term outcomes, especially in patients with aggressive phenotype breast cancer. In addition, this approach provides the unique opportunity to escalate adjuvant therapy in those with residual disease after NAC. Neoadjuvant chemotherapy in breast cancer is a rapidly evolving topic with tremendous interest in ongoing clinical trials. Here, we review the improvements and further challenges in the NAC setting in translational breast cancer research.

Can MRI accurately identify which patients with operable breast cancer will have a pathologic complete response after neoadjuvant therapy?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 616-616
Author(s):  
Carolyn Nessim ◽  
Isabelle Trop ◽  
Andre Robidoux ◽  
Eleftherios P Mamounas ◽  
Jean-Francois Boileau
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Neoadjuvant Therapy ◽  
Predictive Value ◽  
Triple Negative ◽  
Residual Disease ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Breast Cancers ◽  
Number Of Patients

616 Background: With the introduction of targeted therapy based on tumor subtypes, an increasing number of patients that receive neoadjuvant chemotherapy achieve a pathologic complete response (pCR). Previous studies have shown that the accuracy of MRI is poor at predicting the response to neoadjuvant chemotherapy in locally advanced and often non-resectable breast cancers, where the rate of pCR is low. The purpose of this study is to evaluate MRI’s ability to predict a pCR in operable breast cancers after neoadjuvant therapy. Methods: All patients enrolled in the NSABP B-40, B-41, FB-5 and FB-6 protocols in a single tertiary care centre, that had an MRI done before and after neoadjuvant therapy were reviewed. A radiologist, blinded to the pathology results, interpreted the pre- and post- treatment MRI’s and made a prediction as to whether or not patients would have a pCR. In this study, a true negative was defined as a reading of a complete response on MRI that was confirmed as a pCR on final pathology. pCR was defined as having no residual invasive or in situ disease in the breast. Results: 129 women with a median age of 51 years were identified. 90% had invasive ductal carcinoma; 8% had invasive lobular. 58% were ER+, 21% were triple negative and 21% were Her2+. 16% of patients had a pCR. 25% of patients had no residual invasive cancer in the breast. pCR rates for ER+ tumors was 5%, triple negative 37%, and Her2+ 26%. 19% of patients that had a pCR had a total mastectomy. The sensitivity and specificity of MRI for predicting residual disease were 88% and 52% respectively. The positive predictive value was 90% and the negative predictive value was 46% with an accuracy of 82%. Conclusions: MRI has limited value for determining which patients had a pCR after neoadjuvant chemotherapy, even in operable breast cancers. When residual disease is suspected on MRI, it is unlikely that a pCR has been achieved. Surgical excision following neoadjuvant therapy remains the gold standard to identify which patients have achieved a pCR. Other modalities will need to be used in order to accurately determine which patients would be eligible for studies evaluating non operative management following neoadjuvant therapy.

scholarly journals The Prognostic Impact of Body Composition for Locally Advanced Breast Cancer Patients Who Received Neoadjuvant Chemotherapy

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 608
Author(s):  
Toshiaki Iwase ◽  
Aaroh Parikh ◽  
Seyedeh S. Dibaj ◽  
Yu Shen ◽  
Tushaar Vishal Shrimanker ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Composition ◽  
Adipose Tissue ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Advanced Breast

Our previous study indicated that a high amount of visceral adipose tissue was associated with poor survival outcomes in patients with early breast cancer who received neoadjuvant chemotherapy. However, inconsistency was observed in the prognostic role of body composition in breast cancer treatment outcomes. In the present study, we aimed to validate our previous research by performing a comprehensive body composition analysis in patients with a standardized clinical background. We included 198 patients with stage III breast cancer who underwent neoadjuvant chemotherapy between January 2007 and June 2015. The impact of body composition on pathologic complete response and survival outcomes was determined. Body composition measurements had no significant effect on pathologic complete response. Survival analysis showed a low ratio of total visceral adipose tissue to subcutaneous adipose tissue (V/S ratio ≤ 34) was associated with shorter overall survival. A changepoint method determined that a V/S ratio cutoff of 34 maximized the difference in overall survival. Our study indicated the prognostic effect of body composition measurements in patients with locally advanced breast cancer compared to those with early breast cancer. Further investigation will be needed to clarify the biological mechanism underlying the association of V/S ratio with prognosis in locally advanced breast cancer.

scholarly journals Neoadjuvant Therapy in Operable Breast Cancer: Application to Triple Negative Breast Cancer

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Foluso O. Ademuyiwa ◽  
Matthew J. Ellis ◽  
Cynthia X. Ma
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Chemotherapy Resistance ◽  
Treatment Strategies ◽  
Surrogate Endpoint ◽  
Complete Response

Systemic treatment for triple negative breast cancer (TNBC: negative for the expression of estrogen receptor and progesterone receptor and HER2 amplification) has been limited to chemotherapy options. Neoadjuvant chemotherapy induces tumor shrinkage and improves the surgical outcomes of patients with locally advanced disease and also identifies those at high risk of disease relapse despite today’s standard of care. By using pathologic complete response as a surrogate endpoint, novel treatment strategies can be efficiently assessed. Tissue analysis in the neoadjuvant setting is also an important research tool for the identification of chemotherapy resistance mechanisms and new therapeutic targets. In this paper, we review data on completed and ongoing neoadjuvant clinical trials in patients with TNBC and discuss treatment controversies that face clinicians and researchers when neoadjuvant chemotherapy is employed.

Monitoring cytokeratin19 (KRT19) levels as response of circulating tumor cells (CTC) to neoadjuvant chemotherapy (NAC) in breast cancer (BC).

2009 ◽  
Author(s):  
AL Guerrero-Zotano ◽  
M Garcia-Casado ◽  
A Fernandez-Serra ◽  
J Lopez-Guerrero ◽  
J Gavila ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Tumor Cells ◽  
Circulating Tumor Cells
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