scholarly journals Evaluation of clinical and pathological response factors to neoadjuvant chemotherapy in breast cancer patients

Mastology ◽  
2021 ◽  
Vol 31 ◽  
Author(s):  
Rayane Ferreira ◽  
Maximiliano Cassilha Kneubil ◽  
Janaina Brollo ◽  
Luiza Herdy Boechat Luz Tiago ◽  
Karen Bazzo Goulart ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Triple Negative ◽  
Histological Grade ◽  
Disease Free Survival ◽  
Clinicopathological Features ◽  
Her2 Status ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Luminal B

Objectives: To evaluate breast cancer (BC) patients treated with neoadjuvant chemotherapy (NACT) and to analyze clinicopathological features correlating with pathological complete response (PCR) and survival outcomes. Methods: Observational, descriptive, and retrospective study. The medical records of BC patients who underwent NACT were reviewed and analyzed using the Statistical Package for the Social Sciences (SPSS), version 20.0. Results: Of the 176 BC patints who underwent NACT, 62 patients (35.2%) achieved PCR. The PCR rate was 22% (n = 2) for luminal A, 15% (n = 9) for luminal B/HER2-negative, 45.5% (n = 15) for luminal B/HER2-positive, 50% (n = 14) for non-luminal/HER2-positive, and 47.8% (n = 22) for triple-negative (p = 0.01). Histological grade, estrogen receptor (ER) expression, progesterone receptor (PR) expression, and HER2 status were significantly associated with PCR (p = 0.022, p = 0.01, p = 0.01, and p = 0.02, respectively). The median follow-up was 35.9 months, the estimated 5-year disease-free survival (DFS) was 96.7% in the PCR group and 83.2% in the non-PCR group (p = 0.05). The estimated 5-year overall survival (OS) was 95.5% in the PCR group and 69.1% in the non-PCR group (p = 0.017). Overall, 11 patients (6.25%) presented with locoregional recurrence (LRR), one (1.6%) in the PCR group and 10 (8.8%) in the non-PCR group (p = 0.10). Conclusion: We observed higher PCR rates in triple-negative and HER2-positive molecular subtypes. DFS and OS were significantly better in patients who achieved PCR, regardless of clinicopathological features. We also observed lower rates of LRR in the population that reached PCR.

Prognostic factors in breast cancer patients evaluated by PET/CT prior to neoadjuvant chemotherapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12113-e12113
Author(s):  
Mark K Farrugia ◽  
Geraldine M. Jacobson ◽  
Mohamad Adham Salkeni
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Triple Negative ◽  
Primary Breast Tumor ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
Pet Ct ◽  
Pre Treatment

e12113 Background: Neoadjuvant chemotherapy (NAC) is an important modality in breast cancer treatment. We sought to identify pre-treatment prognostic factors in patients who had positron emission tomography paired with diagnostic quality contrast-enhanced CT (PET/CT) prior to neoadjuvant chemotherapy with respect to pathologic complete response (pCR) , survival and relapse-free survival (RFS). Methods: We retrospectively analyzed 118 breast cancer patients who had pre-treatment PET/CT imaging and received NAC from 2008-2014. We collected data on molecular markers, PET/CT, pCR, survival, and disease status. Results: The median follow up was 44 months(range 7.3-101.5),median age was 51 years; 47% were stage II, 53% stage III. 52% of patients had hormone receptor (HR) positive/HER2 negative disease, 31% of tumors were HER2 positive, and 17% of tumors were triple-negative. 92.5% with HER2 positive tumors received NAC containing at least one HER2 targeted agent. Pre-treatment standard uptake value (SUV) max of the primary breast tumor showed no statistically significant relationship to survival, RFS, or pCR. PET avid (>2 SUV) extra-axillary nodes such as internal mammary and supraclavicular was associated with a non-statistically significant trend towards reduced RFS (p=0.06, HR=0.13-1.06). pCR overall was 37.5% for HER2 positive tumors, 15% in triple-negative tumors, and 8% in HR positive/HER2 negative tumors. Log-rank analysis with post-hoc pairwise comparisons showed a significant difference between the RFS of triple-negative tumors and HER2 positive tumors (p=0.001), while comparison between HR positive/HER2 negative and HER2 positive was not statistically significant (p=0.11). Multivariate cox regression analysis, which included grade and stage of tumors, showed HER2 positivity to be associated with a favorable outcome (p=0.04, HR=0.22 (0.05-0.94)). Conclusions: Within this cohort, pre-treatment SUV max of the primary tumor showed no prognostic value with regard pCR or RFS. PET avid extra-axillary metastasis trended towards reduced RFS. Patients with HER2 positive tumors had the highest pCR and RFS comparable to classically favorable subgroups such as HR positive/HER 2 negative.

Predictors of Response and Survival Outcomes of Triple Negative Breast Cancer Receiving Neoadjuvant Chemotherapy

Chemotherapy ◽  
2020 ◽  
Vol 65 (3-4) ◽  
pp. 101-109
Author(s):  
Meizhen Zhu ◽  
Yang Yu ◽  
Xiying Shao ◽  
Liang Zhu ◽  
Linbo Wang
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Histological Grade ◽  
Disease Free Survival ◽  
Complete Response ◽  
Survival Outcomes ◽  
Ki 67 ◽  
Pre Treatment

<b><i>Background:</i></b> In triple negative breast cancer (TNBC) patients receiving neoadjuvant chemotherapy (NACT), pre-treatment predictors for pathological complete response (pCR) have been reported; however, those for progressive disease (PD) remain unidentified. <b><i>Methods:</i></b> We investigated pre-treatment clinicopathological predictors associated with pCR and PD by retrospectively reviewing data for 165 patients treated between 2015 and 2018. Patients with pCR and PD were compared to those without pCR and PD, respectively, using logistic regression and Kaplan-Meier methods. <b><i>Results:</i></b> Lack of androgen receptor (AR) was an independent predictor of pCR, while high histological grade, low Ki-67 index, and incomplete NACT courses were independent predictors of PD. Mean disease-free survival and overall survival were significantly poorer in PD patients than in pCR patients (15.7, 21.3 vs. 52.4, 56.3 months). <b><i>Conclusions:</i></b> Insights into the chemo-resistance mechanisms and exploration of novel targeted agents in subgroups as per AR and Ki-67 status are needed to improve survival outcomes in TNBC patients.

Response-Guided Neoadjuvant Chemotherapy for Breast Cancer

2013 ◽  
Vol 31 (29) ◽  
pp. 3623-3630 ◽  
Author(s):  
Gunter von Minckwitz ◽  
Jens Uwe Blohmer ◽  
Serban Dan Costa ◽  
Carsten Denkert ◽  
Holger Eidtmann ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Early Breast Cancer ◽  
Hormone Receptor ◽  
Triple Negative ◽  
Pathologic Complete Response ◽  
Exploratory Analysis ◽  
Her2 Positive ◽  
Luminal B ◽  
Hormone Receptor Positive

Purpose We investigated disease-free survival (DFS) and overall survival (OS) after response-guided neoadjuvant chemotherapy in patients with early breast cancer. Patients and Methods We treated 2,072 patients with two cycles of docetaxel, doxorubicin, and cyclophosphamide (TAC) and randomly assigned early responders to four (n = 704) or six (n = 686) additional TAC cycles, and early nonresponders to four cycles of TAC (n = 321) or vinorelbine and capecitabine (NX; n = 301) before surgery. Results DFS was longer in early responders receiving TAC × 8 than in those receiving TAC × 6 (hazard ratio [HR], 0.78; 95% CI, 0.62 to 0.97; P = .026), and in early nonresponders receiving TAC-NX than in those receiving TAC × 6 (HR, 0.59; 95% CI, 0.49 to 0.82; P = .001). Exploratory analysis showed that DFS after response-guided chemotherapy (TAC × 8 or TAC-NX) was significantly longer (HR, 0.71; 95% CI, 0.60 to 0.85; P < .003), as was OS (HR, 0.79; 95% CI, 0.63 to 0.99; P = .048), than on conventional chemotherapy (TAC × 6). DFS was longer after response-guided chemotherapy in all hormone receptor–positive tumors (luminal A HR = 0.55, luminal B [human epidermal growth factor receptor 2 (HER2) negative] HR = 0.40, and luminal B [HER2 positive] HR = 0.56), but not in hormone receptor–negative tumors (HER2 positive [nonluminal] HR = 1.01 and triple negative HR = 0.87). Pathologic complete response did not predict these survival effects. pCR predicted an improved DFS in triple-negative (HR = 6.67), HER2-positive (nonluminal; HR 5.24), or luminal B (HER2-negative) tumors (HR = 3.74). Conclusion This exploratory analysis suggests that response-guided neoadjuvant chemotherapy might improve survival and is most effective in hormone receptor–positive tumors. If confirmed, the response-guided approach could provide a clinically meaningful advantage for the neoadjuvant over the adjuvant approach in early breast cancer.

Đánh giá kết quả điều trị tân bổ trợ ung thư vú tại Bệnh viện Ung bướu Đà Nẵng

2020 ◽  
Author(s):  
Tinh Bui Thanh
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Triple Negative ◽  
Ductal Carcinoma ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Her2 Status ◽  
Breast Cancer Patients

Background: Neoadjuvant chemotherapy for breast cancer was used to downstaging tumours to facilitate breast-conserving surgery. Methods: A descriptive retrospective study of 93 breast cancer patients at Da Nang Oncology Hospital from January 2017 to December 2019. Patients diagnosed with locally advanced breast cancer cT2-4N0- 3M0. Exclude cases of Ductal carcinoma in situ from breast or previously treated. Results: an average age of 48, an average tumor size of 6.0 cm, the majority were Invasive ductal carcinoma (97.8%) and grade 2 ( 85.6%). Hormon receptor positive in 57%, HER-2 positive in 38.7% and 18.3% triple negative Breast cancer. The combination chemotherapy regimen Anthacycline and Taxane accounted for 94.7%, Trastuzumab-based regimen accounted for 25%. There was 8.3% progression of disease during neoadjuvant chemotherapy. About Surgery: Breast- conserving surgery in 20.5%, Breast reconstruction in 6.8%, Mastectomy in 71.6%, Sentinel lymph node biopsy in 4.3%. Her2 status was significantly different between the groups with and without pCR.. Endocrine receptors are negative, Ki67 is high, and Triple negative has a higher rate of pCR but not statistically significant. Conclusion: Neoadjuvant chemotherapy helps to downstaging tumours to facilitate breast-conserving surgery. Her2 status is correlated with the rate of complete pathological response (pCR).

Adding cisplatin to an anthracycline-based primary chemotherapy in triple-negative (TN) and non-triple negative (non-TN) T4 breast cancer patients (pts): Long-term outcomes

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 583-583
Author(s):  
M. Ionta ◽  
F. Atzori ◽  
M. Murgia ◽  
B. Frau ◽  
M. Barca ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Her2 Status ◽  
Breast Cancer Patients ◽  
Long Term Outcomes ◽  
Her2 Positive ◽  
Highly Sensitive ◽  
Platinum Agents

583 Background: Clinical data demonstrated that standard anthracycline-based chemotherapy may be less beneficial in TN. Conversely, there is extensive preclinical work showing that TN tumors are highly sensitive to platinum agents. Only a few studies compared cisplatin vs non-cisplatin containing regimens among TN or non-TN homogeneous populations. The aim of this study was to evaluate the efficacy in terms of long-term outcomes of adding cisplatin to an anthracycline-based neoadjuvant regimen (cisplatin, C) compared with a standard anthracycline-based (Non-C) regimen in T4 breast cancer according to TN or non-TN status. Methods: We retrospectively analyzed 125 consecutive T4 breast cancer pts available for ER/PR and HER2 status; 98 pts (80%) were non-TN, of whom 63 treated with Non-C and 35 treated with C regimen; 27 pts (20%) were TN, of whom 10 treated with Non-C and 17 treated with C regimen. All pts received CMF, RT and hormone-therapy if indicated as adjuvant setting. None of the HER2 positive pts received peri-operative trastuzumab. Results: At a median follow-up of 101 months (8–217), estimated 10-year DFS and OS in TN pts treated with C were 47% and 59% versus 10% and 30% in pts treated with Non-C. In non-TN pts DFS and OS were 57% and 70% in pts treated with C versus 37% and 49% in pts treated with Non-C. Conclusions: Our data suggest that both TN and non-TN pts derive a better outcomes from the add of cisplatin over a standard anthracycline-based regimen. Of note, the magnitude of the benefit of cisplatin appears greater in the TN group. In order to validate these findings large prospective randomized trials are warranted. [Table: see text] No significant financial relationships to disclose.

Results of a novel neoadjuvant chemotherapy (NAC) regimen for breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11610-e11610
Author(s):  
Noridza Rivera-Rodriguez ◽  
Fernando Cabanillas ◽  
Lesley Lawrenson ◽  
Viviana Negron ◽  
Orestes Antonio Pavia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Triple Negative ◽  
Pathologic Complete Response ◽  
Disease Free Survival ◽  
Complete Response ◽  
Her2 Positive ◽  
Free Survival ◽  
Residual Cancer Burden ◽  
Significant Difference

e11610 Background: Achieving a pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) has been associated with improved disease free survival (DFS) and overall survival (OS). The Residual Cancer Burden Score (RCB) method is a useful tool that predicts DFS and OS after NAC. We present the results of pts with either triple negative or HER2 positive breast cancer treated with a novel NAC. Methods: 34 pts with localized breast cancer >1 cm with HER2+ (N=19) or triple negative breast cancer (TNBC) (N=15) were treated with this novel regimen consisting first of TEC (docetaxel 75 mg/m2, epirubicin 80 mg/m2, and cyclophosphamide 500 mg/m2) + PEG Filgrastim x 4 cycles. Following the 4th course, TNBC patients received 4 additional TEC cycles if they achieved CR by MRI, or were switched to a non cross-resistant regimen (vinorelbine, bevacizumab, capecitabine) if they had < CR. HER2+ pts received TEC x4 followed by docetaxel + trastuzumab x 4. RCB score was used to measure pathologic response. Pretreament PET scan was done and repeated after course 1 in order to correlate with RCB. Results: Median age was 56 (58 for Her2+ and 49 for TNBC). RCB= 0 (pCR) was achieved in 76%, while only 1 responded poorly (RCB=3). There was no significant difference in the pCR rate between Her2+ and TNBC patients (74% vs 80% respectively), but there was a difference in the rate of pCR without DCIS and invasive cancer between these two (see table, p=0.034). Pts with SUV drop > 5% after 1st TEC had 84% pCR while none with < 5% achieved pCR (p=0.001). Comparison of our results with other NAC regimens reported in the literature is summarized in the table below. Conclusions: This novel chemotherapy approach results in a high pCR rate and RCB 0-1, which have been associated with improved clinical outcomes. Early PET can predict pCR. Although sample size is modest, results are encouraging and deserve further evaluation. Clinical trial information: NCT 00830544. [Table: see text]

Impact of malnutrition and anemia at diagnosis in both: Pathological response and tumor-infiltrating-lymphocytes post neoadjuvant chemotherapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12654-e12654
Author(s):  
Katia MERCEDES Roque ◽  
Marco Galvez Nino ◽  
Carlos Arturo Castaneda Altamirano ◽  
Miluska Castillo Garcia ◽  
Joselyn Sanchez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Histological Grade ◽  
Tumor Infiltrating Lymphocytes ◽  
Pathological Response ◽  
Breast Cancer Patients ◽  
Long Term Outcomes ◽  
Luminal B ◽  
Infiltrating Lymphocytes

e12654 Background: The response after neoadjuvant chemotherapy (NAC) is the main prognostic factor in breast cancer (BC), likewise, malnutrition, anemia and systemic inflammation have also been associated to prognosis in breast cancer. We evaluated the association between pathological response (PR) and tumor infiltrating lymphocytes (TILs) post NAC with nutritional predictors as body mass index (BMI), prognostic nutritional index (PNI), anemia and neutrophil/lymphocyte index (N/L). Methods: This is a retrospective analysis of women diagnosed with BC between 2006 to 2017 at Instituto Nacional de Enfermedades (INEN) who received NAC. Pathological response was classified through residual cancer burden (RCB) and TILs post NAC which were prospectively evaluated by a pathologist. Clinical and pathological features as well as survival status were obtained from patient files. Results: We identified 439 women with BC who received NAC. Median age was 49 years, histological grade 3 was found in 245 patients (55.8%) and stage IIIB was the most frequent at diagnosis with 257 patients (58.5%). Luminal B subtype was the most frequent (43.7%). Rate of pCR was 10.5% and median TILs post NAC was 20%. About nutritional predictors, we use the median as a cutoff to discriminate between high and low values, for BMI was 27.5, for PNI was 56, for hemoglobin was 13.2 and for NLR was 1.84. There was no association for TILs post NAC with BMI (p = 0.38), PNI (p = 0.057) and hemoglobin (p = 0.43). We found a positive association between ILN and TILs post NAC (p = 0.001). On the other hand, we don’t found association for RCB with BMI (p = 0.45), PNI (p = 0.641), ILN (p = 0.2) and hemoglobin (p = 0.15). In the multivariate analysis, only RCB was an independent predictor for DFS (95 % CI, 87-100.5; p = 0.00001) and OS (95 % CI, 101.8-114.1; p = 0.00001). There was no association between BMI, PNI, ILN and anemia with OS and DFS. For the TILs post NAC there was a tendency to association with DFS (p = 0.07) and OS (p = 0.07). Conclusions: There are association between neutrophil/lymphocyte index with TILs after NAC. There was no association between nutritional and systemic predictors with long-term outcomes. The pathologic response is a biomarker for predicting the long-term outcomes of breast cancer patients.

scholarly journals Comparative analysis of the receptor status of the primary focus and synchronous axillary metastases in breast cancer patients

2020 ◽  
Vol 24 (3-6) ◽  
pp. 74-78
Author(s):  
Yu. S. Krumin’ ◽  
V. A. Khailenko ◽  
N. A. Kozlov ◽  
G. Yu. Cheremis ◽  
D. V. Khailenko ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Proliferative Activity ◽  
Molecular Subtype ◽  
Her2 Status ◽  
Breast Cancer Patients ◽  
Luminal A ◽  
Her2 Positive ◽  
Axillary Metastases ◽  
Receptor Status ◽  
Luminal B

The aim of the investigation. To study concordance of surrogate molecular subtype in the pairs of primary and synchronous axillary metastases in patients with invasive breast cancer (IBC). Materials and methods. Retrospective analysis included 80 patients aged 28 to 90 years (average age 40.35.3 years) with a first-time diagnosed IBC who underwent surgical treatment at the N.N. Blokhin National Medical Research Center of Oncology during 20162018 years. None of the patients received any neoadjuvant drug therapy. The pathological evaluation of the estrogen receptors (ER), progesterone receptor (PR), HER2 expression and estimation of proliferative activity (Ki-67 index) with subsequent assignment to surrogate subtypes were performed according to ASCO/CAP protocols and the recommendations of the 20132019 San-Gallen Conference on treatment of Early Breast Cancer. Results. Preliminary results of our study revealed therapeutically significant changes in hormone receptor status, HER2-status and proliferative activity in 12.5% of cases of Luminal A type IBC, 20% of Luminal B/HER2-positive and 4% of Luminal B/Her2-negative subtypes of IBC.

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