Impact of trastuzumab on the pathological complete response (pCR) rates in primary systemic therapy for breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11000-11000
Author(s):  
N. Mizuta ◽  
H. Nakajima ◽  
K. Sakaguchi ◽  
Y. Hachimine ◽  
I. Fujiwara
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Pathological Complete Response ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Breast Conserving Surgery ◽  
Primary Systemic Therapy ◽  
Group A ◽  
Group B

11000 Background: Various regimens of primary systemic therapy (PST) have been performed to patients with locally advanced breast cancer to decrease the size of the primary tumor and allow for effective local and distant control. In terms of pathological complete response (pCR) rate, however, satisfactory results were not obtained. Therefore, in this study, we have tried to determine whether the addition of trastuzumab on PST could increase pCR rate. Methods: Two prospective nonrandomized studies were performed that used different regimens as PST, followed by breast conserving surgery. Group-A ; Eighty-fore HER2-negative patients with operable breast cancer were assigned to 4 cycles of epirubicin and cyclophosphamide followed by 12 cycles of weekly paclitaxel. GroupB; Eighteen HER2-positive patients were assigned to 4 cycles of epirubicin and cyclophosphamide followed by 12 cycles of weekly paclitaxel and trastuzumab. Results: A total of 102 assessable patients were enrolled, and all the patients have completed the above 2 regimens of PST. Pathological complete response (pCR) rates were 12% in Group-A and 61.1% in Group-B, respectively. Following the PST, 75% of Group-A and all of Group-B patients were able to be subjected to breast conserving surgery. All the toxicities happened in both groups were well controlled in grade 1 or 2. Conclusion: These results indicate that both the PST regimens were safely performed in women with locally advanced breast cancer and allow breast conserving surgery in a high fraction of patients (90%). In addition, significantly high rates of pCR were obtained in patients with use of trastuzumab (p<0.01). No significant financial relationships to disclose.

Comparison of neoadjuvant paclitaxel and carboplatin with neoadjuvant letrozole in postmenopausal patients with receptor-positive locally advanced breast cancer (LABC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 608-608
Author(s):  
D. Sinha ◽  
A. K. Bahadur ◽  
K. Singh ◽  
A. K. Rathi
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Residual Tumor ◽  
Complete Response ◽  
Neoadjuvant Hormonal Therapy ◽  
Co Morbidity ◽  
Group A ◽  
Group B

608 Background: For the treatment of LABC using a regimen with the highest likelihood of shrinking the tumor should improve the outcome. Paclitaxel was the first taxane to show activity in breast cancer. The advent of endocrine therapy in the neoadjuvant setting allows downstaging of tumors with less morbidity. The aromatase inhibitors are now the treatment of choice in neoadjuvant setting for elderly patients with estrogen receptor-positive breast cancer. Methods: This prospective, randomized, comparative study assessed the effect of three cycles of neoadjuvant chemotherapy vs. three months of neoadjuvant hormonal therapy in terms of loss of clinical and pathological primary tumor size. Inclusion criteria required postmenopausal patients with non-metastatic, ER and/or PR positive LABC with no co-morbidity. Forty eligible patients were randomly assigned into 2 groups of 20 patients each: Group A treated with 3 cycles of 3 weekly injections of paclitaxel (175 mg/m2) and carboplatin (AUC 6) assessed after each cycle; group B received oral Letrozole 2.5mg once daily for 3 months assessed every 4 weeks. Surgery was done and primary specimen was pathologically examined. Results: Clinically mean loss in primary residual tumor compared to volume at presentation in group A vs. group B at 1st review was 45% vs. 35% (p: 0.536), 63% vs. 57% at second (p: 0.176), and 71% vs. 74% at third review (p: 0.062).Clinical complete response (WHO criteria) and stable disease each were seen in 14% in either group of patients (p: 0.632), partial response in 65% group A and in 72% group B (p: 0.117); no progressive disease was seen in either. All patients underwent surgery. The mean pathological primary cell kill in group A vs. group B was 81% vs.78 %(p:0.918). Resected nodes were pathologically positive for tumor in 47% group A and 60% group B patients (p: 0.269). Conclusions: Neoadjuvant hormonal therapy using oral Letrozole in receptor positive LABC in post menopausal women is as effective as three weekly paclitaxel and carboplatin in downstaging the tumor. No significant financial relationships to disclose.

Radioimmunoguided surgery after primary treatment of locally advanced breast cancer.

1996 ◽  
Vol 14 (5) ◽  
pp. 1599-1603 ◽  
Author(s):  
P Percivale ◽  
S Bertoglio ◽  
P Meszaros ◽  
G Canavese ◽  
F Cafiero ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Primary Tumor ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Advanced Breast ◽  
Primary Chemotherapy ◽  
Radioimmunoguided Surgery ◽  
Group A ◽  
Group B

PURPOSE To assess the role of radioimmunoguided surgery (RIGS) using a handheld intraoperative gamma-detecting probe (GDP) to identify neoplastic disease after primary chemotherapy in locally advanced breast cancer (LABC) patients injected with iodine 125-labeled monoclonal antibodies (MAbs). PATIENTS AND METHODS Twenty-one patients with histologically documented LABC were treated with a combined modality approach. After three courses of primary chemotherapy and before modified radical mastectomy, the 125I-radiolabeled MAbs B72.3 (anti-TAG72) and FO23C5 (anti-carcinoembryonic antigen [CEA]) were administered to 11 patients (group A) and 10 patients (group B), respectively. At surgery, a GDP was used to locate the primary tumor and to assess possible tumor multicentricity and the presence of ipsilateral axillary metastases. Routine pathologic examination was performed in neoplastic and normal tissue specimens of all 21 patients. In addition, immunohistochemical assay for TAG72 and CEA expression was performed. RESULTS In group A patients, RIGS identified primary tumor in seven of 11 patients (63.3%) and unpalpable multicentric tumor lesions were located in two of four (50%). Positive axillary lymph nodes were histologically documented in eight of 11 patients (72.7%) and RIGS identified three of eight (37.5%). In group B, RIGS located the primary tumor lesion in four of 10 patients (40%); in two cases, the tumor was not clinically evident. Multicentricity was observed in one of two patients and lymph node involvement in three of nine (33.3%). No false-positive results were observed in either group A or B. CONCLUSION RIGS appears to be a safe and reliable technique. However, the MAbs used in this study are not sufficiently specific. RIGS represents a technique for which the full potential for intraoperative assessment of breast cancer lesions can be reached when more specific antibodies become readily available.

scholarly journals CAIX is a predictor of pathological complete response and is associated with higher survival in locally advanced breast cancer submitted to neoadjuvant chemotherapy

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Wilson Eduardo Furlan Matos Alves ◽  
Murilo Bonatelli ◽  
Rozany Dufloth ◽  
Lígia Maria Kerr ◽  
Guilherme Freire Angotti Carrara ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Breast Cancer ◽  
Pathological Complete Response ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Advanced Breast ◽  
Metabolic Reprogramming ◽  
Caix Expression

Abstract Background Locally advanced breast cancer often undergoes neoadjuvant chemotherapy (NAC), which allows in vivo evaluation of the therapeutic response. The determination of the pathological complete response (pCR) is one way to evaluate the response to neoadjuvant chemotherapy. However, the rate of pCR differs significantly between molecular subtypes and the cause is not yet determined. Recently, the metabolic reprogramming of cancer cells and its implications for tumor growth and dissemination has gained increasing prominence and could contribute to a better understanding of NAC. Thus, this study proposed to evaluate the expression of metabolism-related proteins and its association with pCR and survival rates. Methods The expression of monocarboxylate transporters 1 and 4 (MCT1 and MCT4, respectively), cluster of differentiation 147 (CD147), glucose transporter-1 (GLUT1) and carbonic anhydrase IX (CAIX) was analyzed in 196 locally advanced breast cancer samples prior to NAC. The results were associated with clinical-pathological characteristics, occurrence of pCR, disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS). Results The occurrence of pCR was higher in the group of patients whith tumors expressing GLUT1 and CAIX than in the group without expression (27.8% versus 13.1%, p = 0.030 and 46.2% versus 13.5%, p = 0.007, respectively). Together with regional lymph nodes staging and mitotic staging, CAIX expression was considered an independent predictor of pCR. In addition, CAIX expression was associated with DFS and DSS (p = 0.005 and p = 0.012, respectively). Conclusions CAIX expression was a predictor of pCR and was associated with higher DFS and DSS in locally advanced breast cancer patients subjected to NAC.

Impact of body composition on toxicity and pathological complete response in locally advanced breast cancer (BC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 593-593
Author(s):  
Laura Sofia Munoz-Arcos ◽  
Jessica Mayer ◽  
Orli Haken ◽  
Jessica Goldman ◽  
Joseph A. Sparano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Pathological Complete Response ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Tumor Grade ◽  
Complete Response ◽  
Stage Ii ◽  
Her2 Status ◽  
Severe Toxicity ◽  
Logistic Regression Models

593 Background: Obesity, defined as body mass index (BMI) > 30 kg/m2, has been associated with inferior outcomes in localized breast cancer (BC), including lower pathological complete response (pCR) to neoadjuvant chemotherapy (NAC). High BMI is usually associated with excess adipose tissue (AT), but also reflects skeletal muscle (SM) mass. Low SM mass (sarcopenia) has also been associated with inferior outcomes and more chemotherapy-associated toxicity. We aimed to evaluate the association of BMI, AT and SM tissue with pCR and toxicity after NAC for stage II-III breast cancer (BC). Methods: 191 patients with stage II-III BC received NAC, had information regarding baseline BMI, toxicity and pCR to NAC at surgery, and, had abdominal computerized tomography (CT) prior to NAC. Total AT (TAT), visceral AT (VAT), subcutaneous AT (SAT), SM area (SMA) and SM density (SMD) were measured by CT at the L3 level using the TOMOVISION software. SM index (SMI) was calculated (SMA/height) to assess for sarcopenia (SMI < 40). Association linking BMI, SAT, VAT, SMA and SMD to pCR and severe toxicity (ST ≥ grade 3) was evaluated using logistic regression models. Results: Patients were predominantly black (51%) with a median age of 54 years (interquartile range = 45-63). pCR was achieved in 31% (60/191) of patients. Of those, 47% (n = 28/60), 40% (n = 24/60) and 13% (n = 8/60) corresponded to HER2(+), triple negative, and hormone receptor-HR(+)/HER2(-) tumors, respectively. ST occurred in 38% (n = 73/191) of patients. Obesity and sarcopenia were present in 52% (n = 100/191) and 14% (n = 27/191) of patients, respectively. There was a statistically significant association between VAT and pCR (median VAT 95.3 cm2 vs. 121.8 cm2 in the pCR vs. no-pCR groups, respectively, p = 0.03). This association remained after adjusting for age, race, tumor grade, stage, BMI, SMD, HR and HER2 status (p = 0.04). There was a statistically significant association between SMA and ST (mean SMA 123 cm2 vs. 130 cm2 in the ST vs. no-ST groups, respectively, p = 0.03). This association disappeared after adjusting for age, race, BMI, VAT, SAT, and SMD (p = 0.21). Conclusions: This study provides evidence that in patients with stage II-III BC receiving NAC, excess VAT is associated with significantly lower pCR rates, and low SMA is associated with ST. Additional research is needed to elucidate the pathophysiologic mechanisms contributing to these associations.

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