Neoadjuvant therapy with cisplatin in BRCA1-positive breast cancer patients

502 Background: Neoadjuvant chemotherapy is administered to control disease, make surgical resection possible and increase the possibility of breast tissue conservation. A further advantage of neoadjuvant therapy is that it helps to assess chemo-sensitivity to a particular agent. Induction of a pathological complete response (pCR) is one of the primary goals of neoadjuvant therapy in order to achieve a better disease-free and overall survival. Experimental data suggest that BRCA1 related breast cancer may have increased sensitivity to platinum-based chemotherapy, but clinical data are limited. The aim of this study was to evaluate the frequency of complete pathologic response after neo-adjuvant treatment with cisplatin chemotherapy in women with breast cancer and a BRCA1 mutation. Methods: Twenty five women with breast cancer and a BRCA1 mutation with stage I, II, and III breast cancer between December 2006 and December 2008 were entered into this study. Patients were treated with cisplatin 75 mg/m2 intravenously every three weeks for four cycles. After chemotherapy, patients underwent surgery and were assessed for pathologic response in both the breast and axillary lymph nodes. Complete pathologic response was defined as no residual invasive disease in both the breast and axilla, however ductal carcinoma in situ was allowed. Results: Twenty five patients were enrolled in the study. Thirteen patients had tumors of greater than two centimeters (52%) and seven patients had positive lymph nodes at diagnosis (28%). Twenty two patients completed four cycles of cisplatin (88%) and three patients completed two cycles (12%). Clinical complete response was observed in eighteen patients (72%). Pathologic complete response was observed in eighteen patients (72%). Conclusions: Platinum-based chemotherapy is effective in a high proportion of patients with BRCA1-associated breast cancers. Clinical trials are warranted to determine the optimum treatment for this subgroup of breast cancer patients. No significant financial relationships to disclose.

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Magseed®-guided long-term marking of target lymph nodes in neoadjuvant therapy of early breast cancer patients - first experiences and prospectives

10.1055/s-0040-1710735 ◽

2020 ◽

Author(s):

M Thill ◽

T Schnitzbauer

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Neoadjuvant Therapy ◽

Cancer Patients ◽

Early Breast Cancer ◽

Breast Cancer Patients

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Magseed®-guided long-term marking of target lymph nodes in neoadjuvant therapy of early breast cancer patients – first experiences and prospectives

10.1055/s-0040-1717878 ◽

2020 ◽

Author(s):

M Thill ◽

F Khandan ◽

T Schnitzbauer

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Neoadjuvant Therapy ◽

Cancer Patients ◽

Early Breast Cancer ◽

Breast Cancer Patients

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Frozen Sections of Sentinel Lymph Nodes From Breast Cancer Patients Who Undergo Neoadjuvant Therapy Are Accurately Diagnosed Using Telepathology

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz123.001 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S122-S123

Author(s):

Valarie McMurtry ◽

Rachel Factor

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Neoadjuvant Therapy ◽

Cancer Patients ◽

Treatment Effect ◽

Frozen Section ◽

Lobular Carcinoma ◽

Sentinel Lymph Nodes ◽

Breast Cancer Patients ◽

Frozen Sections

Abstract Objectives Telepathology enables histologic diagnosis to be made from a scanned slide visualized on a computer. Frozen sections (FSs) can be performed at remote locations and read by a pathologist at a central site. At our institution, qualifying breast cancer patients are enrolled in clinical trials that require FS on sentinel lymph nodes (SLNs) after neoadjuvant therapy (NAT), including chemotherapy or endocrine therapy. In this setting, histology is complicated by treatment effect and biopsy site changes. Others have reported good accuracy of FSs on SLNs after NAT. We investigated whether pathologists are accurate in diagnosing SLN FSs for such cases while using telepathology. To our knowledge, this has not been reported previously. Methods SLNs were entirely submitted and serially sectioned (2-mm thickness). At least two levels were cut. All FSs were submitted for formalin-fixed, paraffin-embedded permanent sections. A pathology assistant at the remote location prepared the FSs and scanned slides using the VisionTek M6 digital microscope ecosystem (East Dundee, IL). Cases were interpreted by board-certified pathologists who completed training on the VisionTek system. For this study, diagnoses from FSs and permanents were compared. Results Forty-five SLNs from 19 breast neoadjuvant cases were read by VisionTek from March 2017 to January 2019. Forty-three cases (96%) called negative by FSs were confirmed negative (on permanents). One hundred percent called positive by FSs were positive. Four SLN called atypical on FSs were positive. Three of these were neoadjuvant endocrine cases for invasive lobular carcinoma. Two cases called atypical were negative. One of these, called atypical/suspicious, resulted in axillary dissection. This case was reviewed by three pathologists at the time of surgery. It had abundant treatment effect, mimicking carcinoma. Conclusion While pitfalls exist, overall, the diagnostic accuracy of frozen section analysis by telepathology of SLNs from breast cases after neoadjuvant therapy is high.

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