scholarly journals Pathologic Complete Response After Neoadjuvant Chemotherapy and Long-Term Outcomes Among Young Women With Breast Cancer

2017 ◽  
Vol 15 (10) ◽  
pp. 1216-1223 ◽  
Author(s):  
Laura Spring ◽  
Rachel Greenup ◽  
Andrzej Niemierko ◽  
Lidia Schapira ◽  
Stephanie Haddad ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Young Women ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Long Term Outcomes

scholarly journals Long-Term Prognostic Risk After Neoadjuvant Chemotherapy Associated With Residual Cancer Burden and Breast Cancer Subtype

2017 ◽  
Vol 35 (10) ◽  
pp. 1049-1060 ◽  
Author(s):  
W. Fraser Symmans ◽  
Caimiao Wei ◽  
Rebekah Gould ◽  
Xian Yu ◽  
Ya Zhang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Validation Cohort ◽  
Residual Disease ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Her2 Positive ◽  
Free Survival ◽  
Residual Cancer Burden

Purpose To determine the long-term prognosis in each phenotypic subset of breast cancer related to residual cancer burden (RCB) after neoadjuvant chemotherapy alone, or with concurrent human epidermal growth factor receptor 2 (HER2)–targeted treatment. Methods We conducted a pathologic review to measure the continuous RCB index (wherein pathologic complete response has RCB = 0; residual disease is categorized into three predefined classes of RCB index [RCB-I, RCB-II, and RCB-III]), and yp-stage of residual disease. Patients were prospectively observed for survival. Three patient cohorts received paclitaxel (T) followed by fluorouracil, doxorubicin, and cyclophosphamide (T/FAC): original development cohort (T/FAC-1), validation cohort (T/FAC-2), and independent validation cohort (T/FAC-3). Another validation cohort received FAC chemotherapy only, and a fifth cohort received concurrent trastuzumab (H) with sequential paclitaxel and fluorouracil, epirubicin, and cyclophosphamide (FEC; H+T/FEC). Phenotypic subsets were defined by hormone receptor (HR) and HER2 status at diagnosis, classified as HR-positive/HER2-negative, HER2-positive (HR-negative/HER2-positive or HR-positive/HER2-positive), or triple receptor–negative. Relapse-free survival estimates were determined from Kaplan-Meier analysis and compared using the log-rank test. Results Five cohorts (T/FAC-1 [n = 219], T/FAC-2 [n = 262], T/FAC-3 [n = 342], FAC [n = 132], and H+T/FEC [n = 203]) had median event-free follow-up of 13.5, 9.1, 6.8, 16.4, and 7.1 years, respectively. Continuous RCB index was prognostic within each phenotypic subset, independent of other clinical-pathologic variables. RCB classes stratified prognostic risk overall, within each phenotypic subset, and within yp-stage categories. Estimates of 10-year relapse-free survival rates in the four RCB classes (pathologic complete response, RCB-I, RCB-II, and RCB-III) were 86%, 81%, 55%, and 23% for triple receptor–negative; 83%, 97%, 74%, and 52% for HR-positive/HER2-negative in the combined T/FAC cohorts; and 95%, 77%, 47%, and 21% in the H+T/FEC cohort. Conclusion RCB was prognostic for long-term survival after neoadjuvant chemotherapy in all three phenotypic subsets of breast cancer. Our institutional findings should be externally validated.

scholarly journals Association of Pathologic Complete Response to Neoadjuvant Therapy in HER2-Positive Breast Cancer With Long-Term Outcomes

JAMA Oncology ◽  
2016 ◽  
Vol 2 (6) ◽  
pp. 751 ◽  
Author(s):  
Kristine R. Broglio ◽  
Melanie Quintana ◽  
Margaret Foster ◽  
Melissa Olinger ◽  
Anna McGlothlin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Therapy ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Long Term Outcomes ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Positive Breast Cancer

scholarly journals Clinical Outcomes of Stage I to III Triple-Negative Breast Carcinoma in Young Women

2018 ◽  
Vol 4 (Supplement 3) ◽  
pp. 18s-18s
Author(s):  
Shabna Ibrahim ◽  
Asha Arjunan
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Clinical Outcomes ◽  
Young Women ◽  
Triple Negative ◽  
Conflicts Of Interest ◽  
Pathologic Complete Response ◽  
Breast Conservation ◽  
Complete Response ◽  
Early Stage Disease

Purpose Triple-negative breast cancer (TNBC) is a genomically unique disease with aggressive clinical behavior. Breast cancer in young women has grave socioeconomic impact with both treatment and survivorship issues affecting fertility, family life, and careers. A study of the clinical outcomes of patients with TNBC in this subgroup is needed to understand these sociocultural and economic effects. Methods Data from patients age 40 years or younger with biopsy-proven nonmetastatic TNBC who were treated between January 1, 2011, and March 31, 2014, at our institute were procured using a structured proforma. Survival estimates and additional association analyses were performed using the Kaplan–Meier method, χ2 test, Fisher’s exact tests, and Cox proportional hazards regression model. Results One hundred sixty patients were analyzed, with a median follow-up of 54 months (range 4 to 88 months). The majority of patients had early (T2; 46.9%) tumors that were mostly either node negative (40.6%) or N1 (35.6%), with composite stage II (50.7%) disease. Only one third of patients (35%) received neoadjuvant chemotherapy, and the rest were treated with adjuvant chemotherapy. Three fourths of patients (75%) received both anthracyclines and taxanes. After neoadjuvant chemotherapy, one fourth (24.5%) achieved a pathologic complete response, a predictor of good prognosis. The majority of patients (71.2%) underwent modified radical mastectomy, which resulted in a low rate of breast conservation surgery (28.8%). Among those with an indication for radiotherapy, most (80%) received the same. Among all patients, 47 (29.3%) experienced relapse, with a median time of 17.5 months (range, 6 to 84 months) to relapse. Most patients experienced relapse at distant sites (76.5%), with fewer local (10.6%) and regional (6%) relapses. The brain was the single most common site of distant metastasis (38.3%). Bone alone metastases comprised 12.8% of relapses. The 4-year overall survival was 75.2% (SE = 3.5) and the 4-year disease-free survival was 68.3% (SE = 3.7). Additional analyses demonstrated that higher composite stage was associated with significantly lower survival and that attaining a pathologic complete response to neoadjuvant chemotherapy was associated with a statistically significant survival advantage. Conclusion TNBC in young women has poorer survival outcomes compared with other subgroups. Neoadjuvant chemotherapy with the aims of achieving a complete pathologic response should be considered even for early-stage disease. These results justify intensive efforts for socioeconomic support for these women, especially in a developing nation, and focused research into more therapeutic options. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

Association of pathologic complete response following neoadjuvant chemotherapy with survival among young women with breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1122-1122
Author(s):  
Rachel Adams Greenup ◽  
Aditya Bardia ◽  
Julliette M Buckley ◽  
Andrzej Niemierko ◽  
Melissa Camp ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Young Women ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
P Value ◽  
Her 2 ◽  
Disease Free

1122 Background: Neoadjuvant chemotherapy is increasingly being used in the treatment of breast cancer, yet data on efficacy and significance of pathologic complete response (pCR) is limited among young women. We sought to determine whether timing of chemotherapy impacted disease-free (DFS) or overall survival (OS), and whether pCR is associated with improved prognosis among young women with breast cancer. Methods: We performed an IRB-approved review of women ≤40 years old who received treatment for stage I-III breast cancer during 1996-2008 at our institution. DFS and OS were determined through use of state tumor registry, death certificate data, and Social Security Master Death Index. Tumor biology was categorized as hormone receptor positive (HR+), HER-2+, or triple negative (TN) breast cancer. pCR was defined as lack of invasive cancer in the breast and axilla on final pathologic review. Cox regression analyses were conducted to evaluate the hazard ratios (HRs) of the association between chemotherapy and outcomes. Results: 370 women ≤40 years old (median age = 36.5, range: 22-40) were treated with systemic therapy for stage I-III breast cancer. 54.7% of tumors were HR+, 20.9% were HER-2+, and 24.4% were TN. After adjusting for stage, there was no difference in DFS or OS among women who received neoadjuvant versus adjuvant chemotherapy (p=0.6 and 0.5 respectively). pCR following neoadjuvant chemotherapy was higher among HER-2+ (50%) and TN (28.6%) tumors when compared to HR+ tumors (17.6%). Among women who received neoadjuvant chemotherapy, 10-year DFS and OS rates were significantly higher when pCR was achieved when compared to lack of pCR (HR=0.20, p value=0.01 and HR=0.13, p=0.05). pCR with neoadjuvant chemotherapy trended towards higher 10-year DFS and OS when compared to women who received adjuvant chemotherapy (HR=0.30, p value=0.08 and HR=0.20, p=0.1). Conclusions: pCR after neo-adjuvant chemotherapy is associated with improved disease-free and overall survival in young women with breast cancer. Pathologic complete response may be a valuable surrogate marker for survival, and aid in the evaluation of therapeutic efficacy in young breast cancer patients.

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