Measurement of Residual Breast Cancer Burden to Predict Survival After Neoadjuvant Chemotherapy

2007 ◽  
Vol 25 (28) ◽  
pp. 4414-4422 ◽  
Author(s):  
W. Fraser Symmans ◽  
Florentia Peintinger ◽  
Christos Hatzis ◽  
Radhika Rajan ◽  
Henry Kuerer ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Hormone Therapy ◽  
Hormone Receptor ◽  
Residual Disease ◽  
Complete Response ◽  
Hormone Receptor Status ◽  
Pathologic Response ◽  
Cancer Burden ◽  
Receptor Status ◽  
Distant Relapse

PurposeTo measure residual disease after neoadjuvant chemotherapy in order to improve the prognostic information that can be obtained from evaluating pathologic response.Patients and MethodsPathologic slides and reports were reviewed from 382 patients in two different treatment cohorts: sequential paclitaxel (T) then fluorouracil, doxorubicin, and cyclophosphamide (FAC) in 241 patients; and a single regimen of FAC in 141 patients. Residual cancer burden (RCB) was calculated as a continuous index combining pathologic measurements of primary tumor (size and cellularity) and nodal metastases (number and size) for prediction of distant relapse-free survival (DRFS) in multivariate Cox regression analyses.ResultsRCB was independently prognostic in a multivariate model that included age, pretreatment clinical stage, hormone receptor status, hormone therapy, and pathologic response (pathologic complete response [pCR] v residual disease [RD]; hazard ratio = 2.50; 95% CI 1.70 to 3.69; P < .001). Minimal RD (RCB-I) in 17% of patients carried the same prognosis as pCR (RCB-0). Extensive RD (RCB-III) in 13% of patients was associated with poor prognosis, regardless of hormone receptor status, adjuvant hormone therapy, or pathologic American Joint Committee on Cancer stage of residual disease. The generalizability of RCB for prognosis of distant relapse was confirmed in the FAC-treated validation cohort.ConclusionRCB determined from routine pathologic materials represented the distribution of RD, was a significant predictor of DRFS, and can be used to define categories of near-complete response and chemotherapy resistance.

Metabolic characterization of inflammatory breast cancer (IBC) with baseline FDG-PET/CT: Relationship with histopathology, hormone receptor status, and pathologic response after neoadjuvant chemotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1105-1105
Author(s):  
Trisha Youn ◽  
Heather A. Jacene ◽  
Pamela Dipiro ◽  
Yoko Tanaka ◽  
Jennifer Ruth Bellon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metabolic Activity ◽  
Hormone Receptor ◽  
Fdg Pet ◽  
Triple Negative ◽  
Residual Disease ◽  
Tumor Grade ◽  
Hormone Receptor Status ◽  
Pathologic Response ◽  
Receptor Status

1105 Background: Higher metabolic activity on FDG-PET is associated with triple negative (TN) hormone receptor status and invasive ductal histopathology in non-IBC breast cancer. Pts with IBC and a complete pathologic response (pCR) in mastectomy tissue after neoadjuvant chemotherapy (NAC) have a better prognosis compared to pts with residual disease. The objectives were to characterize IBC on baseline FDG-PET with respect to hormone receptor status, tumor grade and to determine if baseline metabolic activity in primary or metastatic lymph nodes (LN) predicts pCR. Methods: This is an IRB-approved retrospective study of 28 pts. SUVmax of primary IBC tumor and local LN metastases were compared between (b/w) pts with pCR versus residual disease, b/w pts with different receptor status (ER, PR, HER2), and b/w pts with different grade tumors (1-3). Results: Baseline SUVmax was higher in 6 pts with TN tumors (median 12.4, range 5.4-29.3) compared with 22 pts with ER+ or PR+ or HER2+ tumors (5.0, 2.0-16.3, p=0.04). SUVmax in local LN metastases tended to be higher in TN tumors vs. others (11.2, 2.7-27.9 vs. 5.4, 2.0-15.5, p=0.06). SUVmax in primary IBC was not different based on tumor grade (p=0.26), but higher SUVmax was seen in metastatic LN in pts with grade 3 vs. 2 tumors (10.5, 2.0-27.9 vs. 4.7, 2.0-10.2, p=0.02). SUVmax of primary IBC tumor was not significantly different b/w pts with pCR (median 10.6, range 2-29.3) vs. residual disease (6.4, 2.5-13.6, p=0.36). No significant difference was seen b/w baseline SUVmax of locally metastatic LN between pts with pCR (9.0, 3.3-27.9) vs. residual disease (6.1, 2.0-16.2, p=0.13). Conclusions: Baseline metabolic activity of primary IBC tumor and locally metastatic LN did not predict pCR at mastectomy. Triple-negative receptor status is associated with higher SUVmax in primary tumor and marginally in metastatic LN suggesting a more aggressive nature. These findings are consistent with data in non-IBC breast cancer.

A new measurement of residual cancer burden to predict survival after neoadjuvant chemotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 536-536 ◽  
Author(s):  
W. Symmans ◽  
F. Peintinger ◽  
C. Hatzis ◽  
H. Kuerer ◽  
V. Valero ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Cox Regression ◽  
Residual Disease ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Continuous Measure ◽  
Residual Cancer ◽  
Cancer Burden ◽  
Residual Cancer Burden ◽  
Ajcc Stage

536 Background: The strength of association between tumor response and survival is critical for neoadjuvant chemotherapy trials. Pathologic complete response (pCR) reliably predicts survival benefit, but residual disease contains a range of pathologic responses that likely contain different prognostic groups, including near complete response and resistance. Methods: Pathologic slides and reports were reviewed from 432 patients in two completed neoadjuvant trials: 1) fluorouracil, doxorubicin and cyclophosphamide (FAC) in 189 patients, and 2) paclitaxel followed by FAC (T/FAC) in 243 patients. Paclitaxel was administered as twelve weekly (n=126) or four 3-weekly cycles (n=117). Residual cancer burden (RCB) was calculated as an index that combines pathologic measurements of primary tumor (size and cellularity) and nodal metastases (number and size). We compared four RCB categories, from RCB-0 (pCR) to RCB-3 (chemoresistant), and post-treatment revised AJCC Stage (0-III) for prediction of distant relapse-free survival (DRFS) in multivariate Cox regression analyses (stratified by ER status). Results: The pCR rate was greater after T/FAC than FAC (24% vs. 16%, LR p<0.05), and after weekly (vs. 3-weekly) paclitaxel in T/FAC (30% vs. 16%, LR p<0.01). In patients with residual disease, RCB measurements were significantly lower after T/FAC than FAC (t-test, p<0.0001), but were not different between paclitaxel schedules in T/FAC. RCB was a continuous predictor of DRFS after T/FAC (HR=1.86, 95%CI 1.51–2.30) or FAC (HR=1.67, CI 1.38–2.01) with median follow-up 5 and 8 years, respectively. The resistant category RCB-3 predicted relapse more strongly than AJCC Stage III and identified a larger group of high-risk patients ( Table ). Conclusions: RCB is a new continuous measure of pathologic response that is defined from routine pathologic materials, represents the distribution of residual disease, is a significant predictor of DRFS, and defines chemotherapy resistance more effectively than revised AJCC Stage. [Table: see text] [Table: see text]

The Effect of Neoadjuvant Chemotherapy on Hormone Receptor Status, HER2/neu and Prolactin in Breast Cancer

2011 ◽  
Vol 97 (6) ◽  
pp. 704-710 ◽  
Author(s):  
José Luiz Pedrini ◽  
Ricardo Francalacci Savaris ◽  
Mario Casales Schorr ◽  
Eduardo Cambruzi ◽  
Melina Grudzinski ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Hormone Receptor ◽  
Hormone Receptor Status ◽  
Receptor Status

Changes in and Prognostic Value of Hormone Receptor Status in a Series of Operable Breast Cancer Patients Treated with Neoadjuvant Chemotherapy

2007 ◽  
Vol 12 (6) ◽  
pp. 636-643 ◽  
Author(s):  
Olivier Tacca ◽  
Frédérique Penault‐Llorca ◽  
Catherine Abrial ◽  
Marie‐Ange Mouret‐Reynier ◽  
Inès Raoelfils ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Hormone Receptor ◽  
Prognostic Value ◽  
Hormone Receptor Status ◽  
Operable Breast Cancer ◽  
Breast Cancer Patients ◽  
Receptor Status

scholarly journals The implications of a pathological complete response of the primary tumour after neoadjuvant chemotherapy for breast cancer on axillary surgery

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Mina M. G. Youssef ◽  
Ahmed A. Metwally ◽  
Tamer M. Manie
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Hormone Receptor ◽  
Pathological Complete Response ◽  
Primary Tumour ◽  
Complete Response ◽  
Hormone Receptor Status ◽  
Her2 Positive ◽  
Axillary Surgery ◽  
Grade 3

Abstract Background Management of the node-positive axilla after neoadjuvant chemotherapy is controversial. The aim of this study is to predict the group of patients who may require a less invasive approach for axillary management. One possible group are patients with pathological complete response of the primary after chemotherapy. Results A unicentral retrospective cohort study including all breast cancer patients with axillary node metastases at presentation who received neoadjuvant chemotherapy resulting in pathological complete response. Pathological complete response in the axillary lymph nodes was recorded. A correlation between the response in the primary tumour and the lymph nodes was assessed. A subgroup analysis was conducted for different biological groups. Complete response was seen in the axillary nodes in 80.5% of patients. Patients with lobular cancer were less likely to show a similar response in the axilla as the primary tumour (p = 0.077). A higher incidence of axillary response was observed in HER2-positive tumours (p = 0.082). All patients with grade 3 tumours achieved complete response in the axilla (p = 0.094). Patients with negative or weak positive hormone receptor status had a significantly higher rate of complete response in the axilla compared to strongly positive hormone receptor status (OR, 7.8; 95% CI, 1.7–34.5; p = 0.007). Conclusion A less invasive axillary surgery may be safely recommended in selected group of node-positive patients after neoadjuvant chemotherapy when the primary tumour shows complete response. This group may include HER2-positive, ER-negative and grade 3 tumours. Less response is expected in ER-positive and lobular carcinoma even with complete response in the primary.

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