1
|
Ivanovic N, Bjelica D, Loboda B, Bogdanovski M, Colakovic N, Petricevic S, Gojgic M, Zecic O, Zecic K, Zdravkovic D. Changing the role of pCR in breast cancer treatment - an unjustifiable interpretation of a good prognostic factor as a "factor for a good prognosis". Front Oncol 2023; 13:1207948. [PMID: 37534241 PMCID: PMC10391828 DOI: 10.3389/fonc.2023.1207948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
Pathologic complete response (pCR) after neoadjuvant systemic therapy (NAST) of early breast cancer (EBC) has been recognized as a good prognostic factor in the treatment of breast cancer because of its significant correlation with long-term disease outcome. Based on this correlation, pCR has been accepted by health authorities (FDA, EMA) as a surrogate endpoint in clinical trials for accelerated drug approval. Moreover, in recent years, we have observed a tendency to treat pCR in routine clinical practice as a primary therapeutic target rather than just one of the pieces of information obtained from clinical trials. These trends in routine clinical practice are the result of recommendations in treatment guidelines, such as the ESMO recommendation "…to deliver all planned (neoadjuvant) treatment without unnecessary breaks, i.e. without dividing it into preoperative and postoperative periods, irrespective of the magnitude of tumor response", because "…this will increase the probability of achieving pCR, which is a proven factor for a good prognosis…". We hypothesize that the above recommendations and trends in routine clinical practice are the consequences of misunderstanding regarding the concept of pCR, which has led to a shift in its importance from a prognostic factor to a desired treatment outcome. The origin of this misunderstanding could be a strong subconscious incentive to achieve pCR, as patients who achieved pCR after NAST had a better long-term outcome compared with those who did not. In this paper, we attempt to prove our hypothesis. We performed a comprehensive analysis of the therapeutic effects of NAST and adjuvant systemic therapy (AST) in EBC to determine whether pCR, as a phenomenon that can only be achieved at NAST, improves prognosis per se. We used published papers as a source of data, which had a decisive influence on the formation of the modern attitude towards EBC therapy. We were unable to find any evidence supporting the use of pCR as a desired therapeutic goal because NAST (reinforced by pCR) was never demonstrated to be superior to AST in any context.
Collapse
Affiliation(s)
- Nebojsa Ivanovic
- Department of Surgical Oncology, University Hospital Medical Center (UHMC) “Bezanijska kosa”, Belgrade, Serbia
- Department of Surgery, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Bjelica
- Department of Surgical Oncology, University Hospital Medical Center (UHMC) “Bezanijska kosa”, Belgrade, Serbia
| | - Barbara Loboda
- Department of Surgical Oncology, University Hospital Medical Center (UHMC) “Bezanijska kosa”, Belgrade, Serbia
| | - Masan Bogdanovski
- Faculty of Philosophy, Department of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Natasa Colakovic
- Department of Surgical Oncology, University Hospital Medical Center (UHMC) “Bezanijska kosa”, Belgrade, Serbia
- Department of Surgery, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Simona Petricevic
- Department of Surgical Oncology, University Hospital Medical Center (UHMC) “Bezanijska kosa”, Belgrade, Serbia
| | - Milan Gojgic
- Department of Surgical Oncology, University Hospital Medical Center (UHMC) “Bezanijska kosa”, Belgrade, Serbia
| | - Ognjen Zecic
- Department of Surgical Oncology, University Hospital Medical Center (UHMC) “Bezanijska kosa”, Belgrade, Serbia
| | - Katarina Zecic
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Darko Zdravkovic
- Department of Surgical Oncology, University Hospital Medical Center (UHMC) “Bezanijska kosa”, Belgrade, Serbia
- Department of Surgery, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
2
|
Acea-Nebril B, García-Novoa A, Cereijo-Garea C, Conde Iglesias C, Bouzón Alejandro A, Díaz Carballada C. Safety and Quality of Life in Women with Immediate Reconstruction with Polyurethane Implants after Neoadjuvant Chemotherapy: Outcomes from The Preq-20 Trial. Cancers (Basel) 2023; 15:cancers15041113. [PMID: 36831457 PMCID: PMC9954288 DOI: 10.3390/cancers15041113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION Various studies have evaluated the impact of neoadjuvant chemotherapy (NAC) on the complications of breast cancer surgery, most of which were retrospective and did not assess the variables related to postoperative risk factors. The aim of this study is to analyse the safety and satisfaction of women included in the PreQ-20 trial who underwent NAC and who underwent mastectomy and immediate reconstruction with prepectoral polyurethane implants. MATERIAL AND METHODS The patients included in the study belong to the prospective study PreQ-20. The study group consisted of patients who underwent immediate reconstruction after primary systemic therapy. The control groups consisted of patients with immediate reconstruction and adjuvant chemotherapy (control group 1) and patients with an infiltrating carcinoma or in situ ductal carcinoma who did not require chemotherapy (control group 2). RESULTS The study included 157 women, 58 (36.9%) of whom underwent primary systemic therapy. The indication for genetic study was significantly greater for the study group (87.9%) than for control groups 1 (49.1%) or 2 (30.4%). Seventy-two (45.9%) of the patients underwent bilateral mastectomy (BM), a procedure that was performed significantly more frequently in the study group (69%) than in control groups 1 (30.2%) or 2 (34.8%). The incidence rate for BM after complete pathologic response was 78%. There were no statistically significant differences in the number of complications between the groups. Implant loss was significantly more frequent in control group 1 (13.2%) than in the study group (3.4%) and control group 2 (2.2%). CONCLUSIONS Mastectomy with prepectoral polyurethane implant reconstruction in patients with neoadjuvant chemotherapy presented a similar incidence of complications compared with patients who underwent primary surgery. There is a high rate of BM in women with NAC.
Collapse
Affiliation(s)
- Benigno Acea-Nebril
- Breast Unit, Department of General Surgery, University Hospital Complex A Coruña, 15006 A Coruña, Spain
| | - Alejandra García-Novoa
- Breast Unit, Department of General Surgery, University Hospital Complex A Coruña, 15006 A Coruña, Spain
- Correspondence: ; Tel.: +34-674089387
| | | | - Carmen Conde Iglesias
- Breast Unit, Ginecology Service, University Hospital Complex A Coruña, 15006 A Coruña, Spain
| | - Alberto Bouzón Alejandro
- Breast Unit, Department of General Surgery, University Hospital Complex A Coruña, 15006 A Coruña, Spain
| | - Carlota Díaz Carballada
- Breast Unit, Ginecology Service, University Hospital Complex A Coruña, 15006 A Coruña, Spain
| |
Collapse
|
3
|
Akbari ME, Ghelichi-Ghojogh M, Nikeghbalian Z, Karami M, Akbari A, Hashemi M, Nooraei S, Ghiasi M, Fararouei M, Moradian F. Neoadjuvant VS adjuvant chemotherapy in patients with locally advanced breast cancer; a retrospective cohort study. Ann Med Surg (Lond) 2022; 84:104921. [DOI: 10.1016/j.amsu.2022.104921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 11/17/2022] Open
|
4
|
Quantitative digital histopathology and machine learning to predict pathological complete response to chemotherapy in breast cancer patients using pre-treatment tumor biopsies. Sci Rep 2022; 12:9690. [PMID: 35690630 PMCID: PMC9188550 DOI: 10.1038/s41598-022-13917-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
Complete pathological response (pCR) to neoadjuvant chemotherapy (NAC) is a prognostic factor for breast cancer (BC) patients and is correlated with improved survival. However, pCR rates are variable to standard NAC, depending on BC subtype. This study investigates quantitative digital histopathology coupled with machine learning (ML) to predict NAC response a priori. Clinicopathologic data and digitized slides of BC core needle biopsies were collected from 149 patients treated with NAC. The nuclei within the tumor regions were segmented on the histology images of biopsy samples using a weighted U-Net model. Five pathomic feature subsets were extracted from segmented digitized samples, including the morphological, intensity-based, texture, graph-based and wavelet features. Seven ML experiments were conducted with different feature sets to develop a prediction model of therapy response using a gradient boosting machine with decision trees. The models were trained and optimized using a five-fold cross validation on the training data and evaluated using an unseen independent test set. The prediction model developed with the best clinical features (tumor size, tumor grade, age, and ER, PR, HER2 status) demonstrated an area under the ROC curve (AUC) of 0.73. Various pathomic feature subsets resulted in models with AUCs in the range of 0.67 and 0.87, with the best results associated with the graph-based and wavelet features. The selected features among all subsets of the pathomic and clinicopathologic features included four wavelet and three graph-based features and no clinical features. The predictive model developed with these features outperformed the other models, with an AUC of 0.90, a sensitivity of 85% and a specificity of 82% on the independent test set. The results demonstrated the potential of quantitative digital histopathology features integrated with ML methods in predicting BC response to NAC. This study is a step forward towards precision oncology for BC patients to potentially guide future therapies.
Collapse
|
5
|
Murakami R, Tani H, Kumita S, Uchiyama N. Diagnostic performance of digital breast tomosynthesis for predicting response to neoadjuvant systemic therapy in breast cancer patients: A comparison with magnetic resonance imaging, ultrasound, and full-field digital mammography. Acta Radiol Open 2022; 10:20584601211063746. [PMID: 34992793 PMCID: PMC8725236 DOI: 10.1177/20584601211063746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background The goals of neoadjuvant systemic therapy (NST) are to reduce tumor volume
and to provide a prognostic indicator in assessing treatment response.
Digital breast tomosynthesis (DBT) was developed and has increased interest
in clinical settings due to its higher sensitivity for breast cancer
detection compared to full-field digital mammography (FFDM). Purpose To evaluate the accuracy of DBT in assessing response to NST compared to
FFDM, ultrasound (US), and magnetic resonance imaging (MRI) in breast cancer
patients. Material and Methods In this retrospective study, 95 stages II–III breast cancer patients
undergoing NST and subsequent surgeries were enrolled. After NST, the
longest diameter of residual tumor measured by DBT, FFDM, US, and MRI was
compared with pathology. Agreements and correlations of tumor size were
assessed, and the diagnostic performance for predicting pathologic complete
response (pCR) was evaluated. Results Mean residual tumor size after NST was 19.9 mm for DBT, 18.7 mm for FFDM,
16.0 mm for US, and 18.4 mm for MRI, compared with 17.9 mm on pathology. DBT
and MRI correlated better with pathology than that of FFDM and US. The ICC
values were 0.85, 0.87, 0.74, and 0.77, respectively. Twenty-five patients
(26.3%) achieved pCR after NST. For predicting pCR, area under the receiver
operating characteristic (ROC) curve for DBT, FFDM, US, and MRI were 0.79,
0.66, 0.68, and 0.77, respectively. Conclusion DBT has good correlation with histopathology for measuring residual tumor
size after NST. DBT was comparable to MRI in assessing tumor response after
completion of NST.
Collapse
Affiliation(s)
- Ryusuke Murakami
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hitomi Tani
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Shinichiro Kumita
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | | |
Collapse
|
6
|
Kolben T, Beyer S, Ghasemi S, Hermelink K, Meister S, Degenhardt T, Himsl I, Edler von Koch F, Kolben TM, Wuerstlein R, Mahner S, Harbeck N, Hester A. Late Presentation at Primary Diagnosis of Breast Cancer: Patients' Personality Characteristics and Attitudes. Breast Care (Basel) 2021; 16:343-349. [PMID: 34602939 DOI: 10.1159/000509597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Breast cancer (BC) is the most common cancer in women worldwide. Despite screening and information efforts, about 10% of patients present with tumor size T3 or T4 at primary diagnosis. Late presentation is associated with more advanced tumor stage and consecutively with worse survival rates. Objective This study aimed to evaluate whether patients with a late presentation at primary BC diagnosis differ in their personality from those with early diagnosis. Methods In this bicentric, observational study, personality traits, positive and negative affectivity, anxiety, spirituality, illness beliefs, and sociodemographic characteristics were assessed in BC patients who presented with T-stages 3 or 4 (late presenters) and T-stages 1 or 2 (controls) at initial diagnosis. Results Forty patients (20 controls, 20 late presenters) were interviewed. "Late presenters" perceived their disease as long lasting and had significantly more "positive affectivity" in the current trait. Although no significant associations were found, there was a trend for late presenters to have higher education levels, less spiritual longing, less accurate explanation of their illness, less anxiety in the trait scale, and more conscientiousness than the controls. Conclusion As patients with late presentation for BC differ in specific psychological and sociodemographic characteristics from patients with early BC, the findings of this pilot project warrant additional investigations to identify further specific characteristics and motivations. Identifying patients at risk for late presentation and encouraging them to accept an earlier diagnosis could help to improve their therapy and, finally, their outcome.
Collapse
Affiliation(s)
- Thomas Kolben
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Susanne Beyer
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Sanaz Ghasemi
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Kerstin Hermelink
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Sarah Meister
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Tom Degenhardt
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Isabelle Himsl
- Department of Obstetrics and Gynecology, Klinikum Dritter Orden, Munich, Germany
| | - Franz Edler von Koch
- Department of Obstetrics and Gynecology, Klinikum Dritter Orden, Munich, Germany
| | - Theresa M Kolben
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Rachel Wuerstlein
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Nadia Harbeck
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Anna Hester
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
7
|
Sharma A, Mahajan S, Agrawal SK, Ahmed R, Dey D. Assessment of skin response in T4b breast carcinoma patients post-neoadjuvant chemotherapy. Ecancermedicalscience 2021; 15:1271. [PMID: 34567256 PMCID: PMC8426019 DOI: 10.3332/ecancer.2021.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Indexed: 12/09/2022] Open
Abstract
Background Breast cancer patients with skin ulcerations, satellite nodules or Peau d'orange at presentation are classified with stage 4 breast cancer (T4b). Neoadjuvant chemotherapy (NACT), followed by mastectomy, is the commonly accepted treatment in such patients for fear of adverse outcomes with breast conservation surgery (BCS) and uncertainty over sparing initially involved skin irrespective of the response to chemotherapy. Identifying patients with skin resolution post-NACT can help surgeons in decision-making. Aim To assess skin response in T4b breast cancer patients post-NACT and find the correlation between various clinical and pathological factors associated with no skin involvement on final histology. Methodology Records of breast cancer patients managed at the Tata Medical Center, Kolkata, with NACT for T4b breast carcinoma patients who underwent mastectomy were reviewed between January 2014 and December 2018. Final histology was checked for dermal involvement with the tumour. The Mann-Whitney U test was used for continuous variables for descriptive data, and Pearson's chi-squared and Fischer's exact tests were applied for categorical data. p-value < 0.05 was taken as significant. Results A total of 285 records mentioning skin involvement were reviewed, out of which 111 patients fulfilled the AJCC criterion. The median age at diagnosis of T4b breast cancer was 50 years. The median clinical size pre-chemotherapy was 7 cm. Residual median tumour size on final histology was reported as 1 cm. 78/111 patients showed a post-NACT response of 50% or more, and 43/111 showed a response of more than 90%. 57 (51.4%) patients showed skin involvement on final histopathology, while 54 (48.6%) patients did not.ER negative tumours were more likely to show no dermal involvement (p = 0.006). Residual tumour size of less than 1 cm on final histology (p < 0.05) and nodal stage were significant predictors of dermal response. Conclusion Approximately half of the T4b breast cancer patients showed resolution of dermal skin involvement post-NACT. ER negative and those with residual tumour size less than 1 cm post-NACT are more likely to show dermal resolution. This can help surgeons plan a BCS or skin sparing mastectomy for such patients who usually end up having a mastectomy.
Collapse
Affiliation(s)
- Abhishek Sharma
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Shagun Mahajan
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | | | - Rosina Ahmed
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Debdeep Dey
- Department of Pathology, Tata Medical Center, Kolkata 700156, India
| |
Collapse
|
8
|
Rao M, Dhanushkodi M. Locally Advanced Breast Cancer—A Narrative Review of Management in the Indian Scenario. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1732785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractLocally advanced breast cancer (LABC) forms a significant proportion of the total breast cancer (BC) burden in the country. It is a heterogeneous entity, encompassing a variety of presentations indicative of advanced disease. The standard of care for the treatment of LABC is multimodal, involving chemotherapy, surgery, radiation, and/or hormonal therapy. With improved understanding of the biology of BC, addition of newer agents of systemic therapy to our armamentarium, advances in surgical techniques and radiation delivery, clinicians are now able to tailor treatment according to the individual and consider a more conservative approach to management (in contrast to a mandatory radical mastectomy, decades ago), disease biology, and stage permitting with better survival outcomes. Here, we review all the treatment modalities and options available to aid a clinician in formulating an optimal treatment plan for a patient presenting with LABC and also how best to tailor the treatment to enable cost effectiveness in the Indian setting.
Collapse
Affiliation(s)
- Manjula Rao
- Consultant Breast Oncosurgeon, Breast CMT, Apollo Proton Cancer Centre, Tharamani, Chennai, Tamil Nadu, India
| | - Manikandan Dhanushkodi
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| |
Collapse
|
9
|
Pathak M, Deo SVS, Dwivedi SN, Sreenivas V, Thakur B, Julka PK, Rath GK. Role of neoadjuvant chemotherapy in breast cancer patients: Systematic review and meta-analysis. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_21_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background: The present systematic review and meta-analysis critically assessed the impact of neoadjuvant chemotherapy (nACT) in comparison to ACT in breast cancer patients in terms of oncological and functional outcomes. Methods: Randomized controlled trials comparing NACT with ACT in breast cancer patients were identified through Medline and Cochrane Register of Controlled Trials on January 21, 2016. Cochrane risk of bias assessment tool was used to assess the risk of bias. Meta-analysis was performed using fixed-effects or random-effects method depending on heterogeneity (I
2). Grading of the evidences was also done. Subgroup meta-analysis on the basis of total preoperative chemotherapy or sandwich chemotherapy was also performed. Results: The present meta-analysis shows increased breast-conserving surgery (BCS) rate (n = 9, risk ratio [95% confidence interval (CI)] = 1.19 [1.03–1.37]) with NACT. Further, NACT was found equally effective regarding overall survival (n = 15, hazard ratio [HR] [95% CI] = 0.98 [0.89–1.08]), disease-free survival (DFS) (n = 14, HR [95% CI] = 1.01 [0.86–1.18]), and distant metastasis (n = 13, HR [95% CI] = 0.97 [0.82–1.16]). Although locoregional recurrence (LRR) rate was noted to be significantly higher in NACT group (n = 15, HR [95% CI] = 1.23 [1.06–1.43]), its significance disappeared (n = 13, HR [95% CI] = 1.17 [0.98–1.40]) by excluding the trials where surgery was not provided for patients with complete tumor response. After excluding such trials, preoperative NACT was associated with increased BCS with similar LRR in ACT group. Discussion: NACT has no major impact on breast cancer survival. However, it is associated with increased BCS rates. NACT downgrades tumor size facilitating more BCSs without increasing LRR. The evidences were graded for all outcomes as high except DFS and BCS as moderate.
Collapse
Affiliation(s)
- Mona Pathak
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - S VS Deo
- Department of Surgical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Bhaskar Thakur
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Kumar Julka
- Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - GK Rath
- Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
10
|
Palshof FK, Lanng C, Kroman N, Benian C, Vejborg I, Bak A, Talman ML, Balslev E, Tvedskov TF. Prediction of Pathologic Complete Response in Breast Cancer Patients Comparing Magnetic Resonance Imaging with Ultrasound in Neoadjuvant Setting. Ann Surg Oncol 2021; 28:7421-7429. [PMID: 34043094 DOI: 10.1245/s10434-021-10117-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/19/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Some subgroups of breast cancer patients receiving neoadjuvant chemotherapy (NACT) show high rates of pathologic complete response (pCR) in the breast, proposing the possibility of omitting surgery. Prediction of pCR is dependent on accurate imaging methods. This study investigated whether magnetic resonance imaging (MRI) is better than ultrasound (US) in predicting pCR in breast cancer patients receiving NACT. METHODS This institutional, retrospective study enrolled breast cancer patients receiving NACT who were examined by either MRI or combined US and mammography before surgery from 2016 to 2019. Imaging findings were compared with pathologic response evaluation of the tumor. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for prediction of pCR were calculated and compared between MRI and US. RESULTS Among 307 patients, 151 were examined by MRI and 156 by US. In the MRI group, 37 patients (24.5 %) had a pCR compared with 51 patients (32.7 %) in the US group. Radiologic complete response (rCR) was found in 35 patients (23.2 %) in the MRI group and 26 patients (16.7 %) in the US group. In the MRI and US groups, estimates were calculated respectively for sensitivity (87.7 % vs 91.4 %), specificity (56.8 % vs 33.3 %), PPV (86.2 % vs 73.8 %), NPV (60.0 % vs 65.4 %), and accuracy (80.1 % vs 72.4 %). CONCLUSIONS In predicting pCR, MRI was more specific than US, but not sufficiently specific enough to be a valid predictor of pCR for omission of surgery. As an imaging method, MRI should be preferred when future studies investigating prediction of pCR in NACT patients are planned.
Collapse
Affiliation(s)
| | - Charlotte Lanng
- Department of Breast Surgery, Rigshospitalet/Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Rigshospitalet/Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cemil Benian
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ilse Vejborg
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Bak
- Department of Radiology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Maj-Lis Talman
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Balslev
- Department of Pathology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Tove Filtenborg Tvedskov
- Department of Breast Surgery, Rigshospitalet/Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
11
|
Cao L, Hue JJ, Freyvogel M, Li P, Rock L, Simpson A, Dietz J, Shenk R, Miller ME. Despite Equivalent Outcomes, Men Receive Neoadjuvant Chemotherapy Less Often Than Women for Lymph Node-Positive Breast Cancer. Ann Surg Oncol 2021; 28:6001-6011. [PMID: 33825080 DOI: 10.1245/s10434-021-09857-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) downstages breast cancer and provides prognostic information. Males with breast cancer are known to receive less treatment overall and have poorer outcomes relative to females. We hypothesized that males would be less likely to receive NAC. PATIENTS AND METHODS Patients with a primary diagnosis of cN1-3 breast cancer were identified in the National Cancer Database (2004-2016). Multivariable logistic regression determined the association between NAC utilization and sex, and the relationship between sex and NAC response, controlling for demographic and tumor factors. Overall survival was analyzed using a multivariable Cox model. RESULTS In total, 196,027 patients (194,010 females, 2017 males) met inclusion criteria. A significantly greater proportion of males underwent mastectomy (80% vs. 60%, P < 0.001), and axillary lymph node dissection (76% vs. 74%, P = 0.022). Overall fewer men received chemotherapy than women (73% vs. 84%, P < 0.001); men also received NAC at a significantly lower rate (26% men vs. 45% women, P < 0.001). After accounting for demographic and oncologic factors including hormone receptor (HR) subtype, females remained more likely to undergo NAC (OR 1.84, P < 0.001). On multivariable analysis, sex was not associated with pathologic response or overall survival after NAC. CONCLUSIONS Although oncologic outcomes after NAC were similar, males with node-positive breast cancer received less NAC and more aggressive surgery than females. These data suggest men achieve outcomes comparable to women with cN1-3 disease, and NAC should be used in appropriate male patients to downstage the breast and axilla.
Collapse
Affiliation(s)
- Lifen Cao
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Jonathan J Hue
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Mary Freyvogel
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Pamela Li
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Lisa Rock
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Ashley Simpson
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Jill Dietz
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Robert Shenk
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Megan E Miller
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA. .,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA.
| |
Collapse
|
12
|
Hasegawa Y, Matsubara N, Kogawa T, Naito Y, Harano K, Hosono A, Onishi T, Hojo T, Shimokawa M, Mukohara T. Neo-Bioscore in Guiding Post-surgical Therapy in Patients With Triple-negative Breast Cancer Who Received Neoadjuvant Chemotherapy. In Vivo 2021; 35:1041-1049. [PMID: 33622900 PMCID: PMC8045094 DOI: 10.21873/invivo.12348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022]
Abstract
AIM Patients with triple-negative breast cancer (TNBC) who have not achieved pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) were considered for adjuvant capecitabine. This study was to explore the utility of the Neo-Bioscore in guiding post-surgical therapy in TNBC. PATIENTS AND METHODS The Neo-Bioscore was calculated for patients with non-metastatic primary breast cancer who received NAC at National Cancer Center Hospital East, Japan. RESULTS A total of 329 patients were evaluated. The Neo-Bioscore stratified prognosis after NAC better than clinical or pathological stage. The Neo-Bioscore performed well in the selection of patients with TNBC with excellent prognoses despite non-pCR; no death was observed in patients who had a Neo-Bioscore of 2, the lowest score in those with TNBC. CONCLUSION The Neo-Bioscore can improve the prognostic stratification of patients after NAC for breast cancer over clinical and pathological staging and may enable the identification of patients with non-pCR TNBC who can avoid additional adjuvant chemotherapy.
Collapse
Affiliation(s)
- Yoriko Hasegawa
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Nobuaki Matsubara
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takahiro Kogawa
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoichi Naito
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kenichi Harano
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ako Hosono
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tatsuya Onishi
- Department of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takashi Hojo
- Department of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Toru Mukohara
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan;
| |
Collapse
|
13
|
Lerebours F, Cabel L, Pierga JY. Neoadjuvant Endocrine Therapy in Breast Cancer Management: State of the Art. Cancers (Basel) 2021; 13:cancers13040902. [PMID: 33670042 PMCID: PMC7926493 DOI: 10.3390/cancers13040902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Over the last ten years, neoadjuvant endocrine therapy (NET) has been increasingly investigated and has gained recognition. NET should not only be used to allow surgery or to improve breast-conserving surgery rates in patients not eligible for NCT, but also as a research tool for the search for endocrine sensitivity biomarkers and targeted therapies, and for prognostic information in ER+/HER2-. Abstract Endocrine therapy is the mainstay of treatment in HR+/HER2- breast cancers, which represent about 70% of all breast cancers. Neoadjuvant therapy has been developed since the 1990s to address several issues, including breast-conserving surgery (BCS) and improvement of survival rates. For a long time, neoadjuvant endocrine therapy (NET) was confined to frail patients in order to improve surgery outcome. Since the 2000s, NET now plays a central role as a research tool for predictive endocrine sensitivity biomarkers and targeted therapies. One of the major issues in early HR+/HER2- breast cancer is to identify patients in whom chemotherapy can be safely withheld. In vivo assessment of response to NET might be the best treatment strategy to address this issue.
Collapse
Affiliation(s)
- Florence Lerebours
- Medical Oncology Department, Institut Curie, 92210 Saint-Cloud, France; (L.C.); (J.-Y.P.)
- Correspondence:
| | - Luc Cabel
- Medical Oncology Department, Institut Curie, 92210 Saint-Cloud, France; (L.C.); (J.-Y.P.)
| | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie, 92210 Saint-Cloud, France; (L.C.); (J.-Y.P.)
- Department of Medicine, University of Paris, 75006 Paris, France
| |
Collapse
|
14
|
Neoadjuvant Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Ther 2021; 28:e150-e156. [PMID: 33369918 DOI: 10.1097/mjt.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Abstract
PURPOSE OF REVIEW Neoadjuvant therapy in melanoma is an area of active investigation with numerous completed and ongoing trials studying a variety of therapeutic interventions utilizing diverse designs. Here, we review completed and ongoing neoadjuvant trials in melanoma, discuss endpoint assessment, and highlight biomarker development in this context. RECENT FINDINGS High-risk resectable melanoma with clinically detectable lymph node (LN) with or without in-transit and/or satellite metastases represent ~ 20% of melanoma patients and have a high risk of relapse despite definitive surgery. Adjuvant therapy with anti-PD-1 immunotherapy or BRAF/MEK-targeted therapy has improved relapse-free survival (RFS) and overall survival (OS) in large phase III trials and is approved for this indication. However, despite surgery and adjuvant therapy, many patients relapse and/or experience treatment-related toxicity, underscoring the need to identify and understand mechanisms of response and resistance. In melanoma, neoadjuvant therapy is an active area of research with numerous completed and ongoing trials utilizing FDA-approved and novel agents with intriguing results. Neoadjuvant therapy for regionally metastatic disease is an established standard in multiple cancers, where it has been shown to improve operability, facilitate biomarker development, and even is a registrational endpoint for drug development in breast cancer. Recently, a spate of neoadjuvant studies in melanoma has looked at a swathe of agents with promising clinical and biomarker results. Coordinated efforts are underway to translate these findings to earlier stage disease while prioritizing the evaluation of new strategies in unresectable disease.
Collapse
|
16
|
Impact of pathologic complete response on survival after neoadjuvant chemotherapy in early-stage breast cancer: a population-based analysis. J Cancer Res Clin Oncol 2019; 146:529-536. [DOI: 10.1007/s00432-019-03083-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
|
17
|
A Review of the Impact of Neoadjuvant Chemotherapy on Breast Surgery Practice and Outcomes. Clin Breast Cancer 2019; 19:377-382. [DOI: 10.1016/j.clbc.2019.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/22/2019] [Indexed: 01/26/2023]
|
18
|
Davoine E, Dion L, Nyangoh Timoh K, Beraud E, Tas P, Tavenard A, Laviolle B, Perrin C, Foucher F, Levêque J, Lavoué V. Predictive factors associated with involved margins in breast cancer treated with neoadjuvant chemotherapy followed by breast-conserving therapy. J Gynecol Obstet Hum Reprod 2019; 48:467-472. [DOI: 10.1016/j.jogoh.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/03/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
|
19
|
Sannachi L, Gangeh M, Tadayyon H, Gandhi S, Wright FC, Slodkowska E, Curpen B, Sadeghi-Naini A, Tran W, Czarnota GJ. Breast Cancer Treatment Response Monitoring Using Quantitative Ultrasound and Texture Analysis: Comparative Analysis of Analytical Models. Transl Oncol 2019; 12:1271-1281. [PMID: 31325763 PMCID: PMC6639683 DOI: 10.1016/j.tranon.2019.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The purpose of this study was to develop computational algorithms to best determine tumor responses early after the start of neoadjuvant chemotherapy, based on quantitative ultrasound (QUS) and textural analysis in patients with locally advanced breast cancer (LABC). METHODS A total of 100 LABC patients treated with neoadjuvant chemotherapy were included in this study. Breast tumors were scanned with a clinical ultrasound system prior to treatment, during the first, fourth and eighth weeks of treatment, and prior to surgery. QUS parameters were calculated from ultrasound radio frequency data within tumor regions. Texture features were extracted from each QUS parametric map. Patients were classified into two groups based on identified clinical/pathological response: responders and non-responders. In order to differentiate treatment responders, three multi-feature response classification algorithms, namely a linear discriminant, a k-nearest-neighbor and a nonlinear support vector machine classifier were compared. RESULTS All algorithms distinguished responders and non-responders with accuracies ranging between 68% and 92%. In particular, support vector machine performed the best in differentiating responders from non-responders with accuracies of 78%, 90% and 92% at weeks 1, 4 and 8 after the start of treatment, respectively. The most relevant features in separating the two response groups at early stages (weeks 1and 4) were texture features and at a later stage (week 8) were mean QUS parameters, particularly ultrasound backscatter intensity-based parameters. CONCLUSION An early stage treatment response prediction model developed by quantitative ultrasound and texture analysis combined with modern computational methods permits offering effective alternatives to standard treatment for refractory patients.
Collapse
Affiliation(s)
- Lakshmanan Sannachi
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mehrdad Gangeh
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Hadi Tadayyon
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sonal Gandhi
- Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frances C Wright
- Surgical Oncology, Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Elzbieta Slodkowska
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Belinda Curpen
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ali Sadeghi-Naini
- Department of Electrical Engineering & Computer Science, York University, Toronto, ON, Canada
| | - William Tran
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Gregory J Czarnota
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
20
|
Burotto M, Wilkerson J, Stein WD, Bates SE, Fojo T. Adjuvant and neoadjuvant cancer therapies: A historical review and a rational approach to understand outcomes. Semin Oncol 2019; 46:83-99. [DOI: 10.1053/j.seminoncol.2019.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
|
21
|
Wong NS. Primary medical therapy and breast conservation treatment: the medical oncology perspective. Gland Surg 2018; 7:560-575. [PMID: 30687629 DOI: 10.21037/gs.2018.10.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Primary systemic therapy (PST) is a widely adopted strategy for increasing operability and breast conservation rates. Although first generation PST trials failed to demonstrate improvements in disease free and overall survival compared to adjuvant systemic therapy (AST), they did demonstrate a strong association between attainment of pathologic complete response (pCR) and improved survival outcomes, leading to the widespread adoption of pCR as the primary endpoint in subsequent PST trials. First generation trials also showed that preoperative PST can improve breast conservation rates and downstage the axilla. Although individual trials did not demonstrate statistically significant increase in local recurrence with PST when compared to AST, a recent meta-analysis did note an increased in such risk, mainly driven by trials in which surgery was omitted in patients with good response to PST. Successive generations of PST clinical trials have since explored the activity of taxanes, optimization of anthracycline and taxane dose and schedules, incorporation of single and dual anti-HER2 therapy in HER2 overexpressing breast cancer, the use of platinums in triple negative breast cancer, and the role of endocrine therapy in hormone receptor positive breast cancer. While these PST trials have generally found increased pCR rates with the introduction of modern chemotherapy regimens and targeted therapies, they have not consistently demonstrated further improvements in breast conservation rates compared to first generation regimens. The reasons for this are complex and may lie beyond differences in anti-tumour activity between different systemic regimens but rather in other potential confounding factors such as tumour to breast volume ratio, tumour location, multicentricity as well as patient or surgeon preference.
Collapse
Affiliation(s)
- Nan Soon Wong
- Oncocare Cancer Centre, Gleneagles Medical Centre, Singapore
| |
Collapse
|
22
|
Yang H, Zhou L, Wang S, Cao Y, Tong F, Liu P, Zhou B, Cheng L, Liu M, Liu H, Xie F, Guo J, Wang S, Peng Y. Retrospective analysis of concurrent docetaxel and epirubicin neoadjuvant versus adjuvant chemotherapy: Which leads to better outcomes for different subtype breast cancer patients? Medicine (Baltimore) 2018; 97:e12690. [PMID: 30290661 PMCID: PMC6200491 DOI: 10.1097/md.0000000000012690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Different biological subtype breast cancers respond differently to neoadjuvant chemotherapy, but it is unknown whether neoadjuvant or adjuvant chemotherapy leads to different long-term survival in each specific subtype although equal outcomes have been reported in general population. This study sought to clarify whether the selection of either neoadjuvant or adjuvant chemotherapy was linked to a differential survival benefit based on breast cancer subtypes.A prospectively maintained breast cancer database was queried from 2000 to 2008. All patients with a diagnosis of stage II and III breast cancer who received neoadjuvant or adjuvant chemotherapy were identified, only patients receiving docetaxel and epirubicin (TA) regimen were included. Patients were divided according to the administration of neoadjuvant or adjuvant chemotherapy. The biological subtypes were determined by immunohistochemical tests. The outcomes between neoadjuvant and adjuvant chemotherapy were compared in each different subtype. Kaplan-Meier curves were generated, and the Cox model was used to estimate the association between death risk and chemotherapy timing while adjusting for potentially confounding factors. P values < .05 were considered statistically significant.Of the 406 patients included, 201 (49.5%) received neoadjuvant chemotherapy, and 205 (50.5%) received an adjuvant TA regimen. Patients with the HER2+ and TNBC subtypes showed significantly higher pCR rates than patients with luminal types (P < .05). In general population, the neoadjuvant and adjuvant chemotherapy groups showed little survival variance (HR=1.15, 95% confidence interval (CI) .69-1.91, P=.60). In luminal B-like patients, neoadjuvant chemotherapy led to worse overall survival (OS) than adjuvant therapy (HR=2.92, 95%CI 1.20 to 8.31, P = .02). In patients with the HER2+ subtype, neoadjuvant treatment corresponded to better OS (HR = .10, 95%CI .02-.58, P = .01). In contrast, patients with luminal A-like (HR = 1.14, 95%CI .53-2.43, P = .74) and TNBC disease (HR = 1.00, 95%CI .27-3.73, P = >.99) who underwent neoadjuvant chemotherapy showed equivalent OS when compared to patients undergoing adjuvant therapy.Neoadjuvant versus adjuvant chemotherapy results in a disparate impact on overall survival among patients with variant subtype breast cancer. When neoadjuvant chemotherapy was given, luminal B-like patients showed worse outcome, while patients with HER2+ disease had better OS. Prospective studies are necessary to determine and optimize the timing of chemotherapy for breast cancers with different molecular backgrounds.
Collapse
Affiliation(s)
- Houpu Yang
- Peking University People's Hospital Breast Center
| | - Lixin Zhou
- Department of Thoracic Surgery, Peking University People's Hospital
| | - Shu Wang
- Peking University People's Hospital Breast Center
| | - Yingming Cao
- Peking University People's Hospital Breast Center
| | - Fuzhong Tong
- Peking University People's Hospital Breast Center
| | - Peng Liu
- Peking University People's Hospital Breast Center
| | - Bo Zhou
- Peking University People's Hospital Breast Center
| | - Lin Cheng
- Peking University People's Hospital Breast Center
| | - Miao Liu
- Peking University People's Hospital Breast Center
| | - Hongjun Liu
- Peking University People's Hospital Breast Center
| | - Fei Xie
- Peking University People's Hospital Breast Center
| | - Jiajia Guo
- Peking University People's Hospital Breast Center
| | - Siyuan Wang
- Peking University People's Hospital Breast Center
| | - Yuan Peng
- Peking University People's Hospital Breast Center
| |
Collapse
|
23
|
Criscitiello C, Golshan M, Barry WT, Viale G, Wong S, Santangelo M, Curigliano G. Impact of neoadjuvant chemotherapy and pathological complete response on eligibility for breast-conserving surgery in patients with early breast cancer: A meta-analysis. Eur J Cancer 2018; 97:1-6. [PMID: 29734046 DOI: 10.1016/j.ejca.2018.03.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE We conducted a meta-analysis of randomised trials evaluating pathological complete response (pCR) and surgical outcomes after neoadjuvant systemic therapy (NST) in patients with early breast cancer (EBC). PATIENTS AND METHODS The primary outcome was breast-conserving surgery (BCT) rate. Secondary outcomes were pCR rate and association to BCT. Meta-analyses were performed using random effects models that use inverse-variance weighting for each treatment arm based on evaluable patients. Point estimates are reported with 95% confidence interval (CI), and p < 0.05 was considered statistically significant. RESULTS Thirty-six studies were identified (N = 12,311 patients). We selected for the analysis 16 of 36 studies reporting both pCR and BCT for at least one treatment arm. Arms per study ranged from one to six; 42 independent units were available to evaluate the association between pCR and BCT. BCT rate ranged 5-76% across arms with an average BCT of 57% (95% CI 52-62%). Significant heterogeneity was observed among the trials (Cochrane Q = 787, p < 0.001, I2 = 97%). In the meta-regression model, BCT rates were not significantly associated with year of first patient-in (p = 0.89), grade (p = 0.93) and hormone-receptor status (p = 0.39). Clinical N-stage (p = 0.01) and human epidermal growth factor receptor (HER2) status (p = 0.03) were significantly associated with BCT. pCR rate ranged 3-60% across studies. The average pCR across all study arms was 24% (95% CI 19-29%). No association was observed between pCR rate in a study arm and the resulting BCT rate in a univariate model (p = 0.34) nor after adjusting for HER2 and clinical nodal status (p = 0.82). In the subset of 14 multi-arm studies, no significant association was seen between the differences in pCR and BCT between treatment arms (p = 0.27). CONCLUSIONS pCR does not increase BCT in patients receiving NST for EBC.
Collapse
Affiliation(s)
- Carmen Criscitiello
- Division of New Drug Development, European Institute of Oncology, Milan, Italy
| | - Mehra Golshan
- Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA; General Surgery, Department of Advanced Biomedical Science, University Federico II, Naples, Italy
| | - William T Barry
- General Surgery, Department of Advanced Biomedical Science, University Federico II, Naples, Italy
| | - Giulia Viale
- Division of New Drug Development, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - Stephanie Wong
- Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Michele Santangelo
- General Surgery, Department of Advanced Biomedical Science, University Federico II, Naples, Italy
| | - Giuseppe Curigliano
- Division of New Drug Development, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy.
| |
Collapse
|
24
|
Chen Y, Shi XE, Tian JH, Yang XJ, Wang YF, Yang KH. Survival benefit of neoadjuvant chemotherapy for resectable breast cancer: A meta-analysis. Medicine (Baltimore) 2018; 97:e10634. [PMID: 29768327 PMCID: PMC5976345 DOI: 10.1097/md.0000000000010634] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) increases breast conservation rates in patients with resectable breast cancer at the associated cost of higher locoregional recurrence rates; however, the magnitude of the survival benefits of NAC for these patients remains undefined. Therefore, we aimed to clarify the survival benefit of NAC versus postoperative chemotherapy by conducting an updated meta-analysis of randomized clinical trials (RCTs). METHODS The authors searched the Cochrane Library, PubMed, Embase, Web of Science, Chinese biomedical literature database, and Chinese Scientific Journals full-text database from their inception to December 2016. The authors identified relevant RCTs that compared NAC with postoperative chemotherapy in the treatment of operable breast cancer. The main endpoints were overall survival (OS) and recurrence-free survival (RFS). RESULTS A total of 21 citations representing 16 unique studies were eligible. There were 787 deaths among 2794 patients assigned to NAC groups and 816 deaths among 2799 patients assigned to adjuvant chemotherapy groups. A meta-analysis of data indicated that there was no significant benefit in terms of OS ([hazard ratio [HR] = 1.03, 95% confidence interval [CI]: 0.94-1.13, P = .51) and RFS (HR = 1.01, 95% CI: 0.93-1.10, P = .80) between the NAC and postoperative chemotherapy groups. The pooled HR estimate for OS was not influenced by NAC cycles, the total number of chemotherapy cycles, administration of tamoxifen, administration of adjuvant chemotherapy, or type of NAC regimen. Subgroup analysis showed that the pooled HR estimate for RFS was influenced by anthracycline-containing regimens. Patients with a pathological complete response had superior survival outcomes compared with patients who had residual disease. CONCLUSION The survival benefits for patients with operable breast cancer who received either NAC or adjuvant chemotherapy based on anthracycline regimens were comparable.
Collapse
Affiliation(s)
- Yan Chen
- The First Hospital of Lanzhou University
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province
| | - Xiu-E Shi
- Department of Internal Medicine, Gansu Rehabilitation Center Hospital
- Center for Evidence-Based Rehabilitation Medicine, Gansu Province
| | - Jin-Hui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province
| | - Xu-Juan Yang
- School of Basic Medical Sciences, Lanzhou University
| | - Yong-Feng Wang
- School of Basic Medical Sciences, Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Ke-Hu Yang
- The First Hospital of Lanzhou University
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province
| |
Collapse
|
25
|
Baltali E, Günel N, Onat DA, Atahan IL, Akçali Z, Büyükünal E, Firat D. Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer: A Preliminary Report. TUMORI JOURNAL 2018; 85:483-7. [PMID: 10774570 DOI: 10.1177/030089169908500611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background A pilot study of neoadjuvant chemotherapy with cyclophosphamide-epirubicin-5-fluorouracil (FEC) was performed on 85 patients with locally advanced breast cancer. Methods and Study Design Patients received four cycles of neoadjuvant chemotherapy followed by surgery, radiotherapy and a treatment with cyclophosphamide-methotrexate-5-fluorouracil for three cycles. Results Major clinical response was obtained in 76 (89%) patients. Complete response was documented in 14 (17%) patients at pathologic examination of surgical specimen. Grade 1-2 nausea and vomiting was the most common (77%) side effect. Grade 2-3 alopecia was 66%. Grade 2-3 neutropenia occurred in 16% of patients. None of the patients developed febrile neutropenia. Sinus tachycardia was observed only in one patient. Three patients had a more than 10% decrease in the left ventricular ejection fraction without any clinical signs. Nine patients had progressive or stable disease and 4 did not undergo surgery or receive radiation therapy; thus 13 were excluded from survival analysis. After a median follow-up of 31 months (range, 15-41), disease-free survival and overall survival were 20 (range, 13-32) and 23 months (range, 17-32). Conclusions The FEC combination is safe and effective for a neoadjuvant setting in locally advanced breast cancer. A longer follow-up is necessary for the end point results.
Collapse
Affiliation(s)
- E Baltali
- Hacettepe University, Institute of Oncology, Department of Medical Oncology, Turkey
| | | | | | | | | | | | | |
Collapse
|
26
|
Baltali E, Altundağ MK, Onat DA, Abbasoğlu O, Ozişik Y, Güler N, Atahan L, Berberoğlu U, Altinok M, Baran I, Celik I, Tekuzman G. Neoadjuvant Chemotherapy with Taxotere-Epirubicin-5-Fluorouracil (TEF) in Local-Regionally Advanced Breast Cancer: A Preliminary Report. TUMORI JOURNAL 2018; 88:474-7. [PMID: 12597141 DOI: 10.1177/030089160208800608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Sixty-three patients with local-regionally advanced breast cancer were treated with neoadjuvant chemotherapy consisting of docetaxel (Taxotere), epirubicin, and 5-fluorouracil (TEF). Methods and study design Preoperatively, patients received four cycles of Taxotere (80 mg/m2), epirubicin (60 mg/m2), and 5-fluorouracil (500 mg/m2), repeated every 21 days. Following completion of four cycles of chemotherapy, appropriate surgery was performed. After the surgery, patients received one cycle of the TEF chemotherapy regimen; following chemotherapy, radiotherapy was applied, and at the end two more cycles of TEF chemotherapy regimen were given. Results Sixty-three patients with locally advanced breast cancer were treated. Three patients were excluded from the study before the evaluation of response. Median age of the patients was 50 years (range, 25–77). Twenty-seven and 33 patients were premenopausal and postmenopausal, respectively. Thirty-nine patients were in stage IIIA and 21 in stage IIIB. Complete and partial responses were observed in 15 (25%) and 42 (70%) of the patients following four cycles of preoperative TEF chemotherapy regimen, respectively. Overall response was 95%, and primary lesion progressed only in 3 (5%) patients. The mean disease-free survival was 15.9 ± 6.8 (range, 3.5–28) months and the mean overall survival was 18.6 ± 7.2 (range, 5–30) months. The most frequent side effects were nausea-vomiting, mucositis, alopecia and leukopenia. Conclusions TEF therapy is a treatment with a high overall response rate and toxicities similar to other taxotere combinations. A longer follow-up of patients is necessary for the determination of disease-free survival and overall survival.
Collapse
Affiliation(s)
- Eşmen Baltali
- Hacettepe University, Institute of Oncology, Department of Medical Oncology, Ankara, Turkey
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Manna EDF, Teixeira LC, Alvarenga M. Association between Immunohistochemical Expression of Topoisomerase IIα, Her2 and Hormone Receptors and Response to Primary Chemotherapy in Breast Cancer. TUMORI JOURNAL 2018. [DOI: 10.1177/030089160609200307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate the association between immunohistochemical expression of topoisomerase IIα, HER2 and hormone receptors and response to primary anthracycline-based chemotherapy in locally advanced breast cancer. We analyzed 109 medical charts of patients treated with primary anthracycline-based chemotherapy in the Women's Integral Health Care Center from 1996 to 2004. The clinical and pathological response to primary chemotherapy was associated with topoisomerase IIα and HER2 expression and hormone receptor negativity. Statistical analysis was performed using chi-squared, Fisher's exact test and Mann-Whitney test. No statistical association between clinical response and expression of topoisomerase IIa, HER2 and hormone receptor negativity was found. However, there was an association between complete pathological response and hormone receptor negativity (P = 0.0289). The present study suggested that these markers should not be considered predictors of response to primary anthracycline-based chemotherapy, and prospective studies must be designed for this purpose.
Collapse
Affiliation(s)
- Eliza Del Fiol Manna
- Department of Obstetrics and Gynecology (Division of Oncology), School of Medical Science, Campinas State University, Campinas, Brazil
| | - Luiz Carlos Teixeira
- Department of Obstetrics and Gynecology (Division of Oncology), School of Medical Science, Campinas State University, Campinas, Brazil
| | - Marcelo Alvarenga
- Department of Obstetrics and Gynecology (Division of Oncology), School of Medical Science, Campinas State University, Campinas, Brazil
| |
Collapse
|
28
|
Sannachi L, Gangeh M, Tadayyon H, Sadeghi-Naini A, Gandhi S, Wright FC, Slodkowska E, Curpen B, Tran W, Czarnota GJ. Response monitoring of breast cancer patients receiving neoadjuvant chemotherapy using quantitative ultrasound, texture, and molecular features. PLoS One 2018; 13:e0189634. [PMID: 29298305 PMCID: PMC5751990 DOI: 10.1371/journal.pone.0189634] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/28/2017] [Indexed: 12/31/2022] Open
Abstract
Background Pathological response of breast cancer to chemotherapy is a prognostic indicator for long-term disease free and overall survival. Responses of locally advanced breast cancer in the neoadjuvant chemotherapy (NAC) settings are often variable, and the prediction of response is imperfect. The purpose of this study was to detect primary tumor responses early after the start of neoadjuvant chemotherapy using quantitative ultrasound (QUS), textural analysis and molecular features in patients with locally advanced breast cancer. Methods The study included ninety six patients treated with neoadjuvant chemotherapy. Breast tumors were scanned with a clinical ultrasound system prior to chemotherapy treatment, during the first, fourth and eighth week of treatment, and prior to surgery. Quantitative ultrasound parameters and scatterer-based features were calculated from ultrasound radio frequency (RF) data within tumor regions of interest. Additionally, texture features were extracted from QUS parametric maps. Prior to therapy, all patients underwent a core needle biopsy and histological subtypes and biomarker ER, PR, and HER2 status were determined. Patients were classified into three treatment response groups based on combination of clinical and pathological analyses: complete responders (CR), partial responders (PR), and non-responders (NR). Response classifications from QUS parameters, receptors status and pathological were compared. Discriminant analysis was performed on extracted parameters using a support vector machine classifier to categorize subjects into CR, PR, and NR groups at all scan times. Results Of the 96 patients, the number of CR, PR and NR patients were 21, 52, and 23, respectively. The best prediction of treatment response was achieved with the combination mean QUS values, texture and molecular features with accuracies of 78%, 86% and 83% at weeks 1, 4, and 8, after treatment respectively. Mean QUS parameters or clinical receptors status alone predicted the three response groups with accuracies less than 60% at all scan time points. Recurrence free survival (RFS) of response groups determined based on combined features followed similar trend as determined based on clinical and pathology. Conclusions This work demonstrates the potential of using QUS, texture and molecular features for predicting the response of primary breast tumors to chemotherapy early, and guiding the treatment planning of refractory patients.
Collapse
Affiliation(s)
- Lakshmanan Sannachi
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mehrdad Gangeh
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Hadi Tadayyon
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ali Sadeghi-Naini
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sonal Gandhi
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frances C. Wright
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Elzbieta Slodkowska
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Belinda Curpen
- Division of Breast Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - William Tran
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Gregory J. Czarnota
- Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- * E-mail:
| |
Collapse
|
29
|
Martelli G, Miceli R, Folli S, Guzzetti E, Chifu C, Maugeri I, Ferranti C, Bianchi G, Capri G, Carcangiu M, Paolini B, Agresti R, Ferraris C, Piromalli D, Greco M. Sentinel node biopsy after primary chemotherapy in cT2 N0/1 breast cancer patients: Long-term results of a retrospective study. Eur J Surg Oncol 2017; 43:2012-2020. [DOI: 10.1016/j.ejso.2017.07.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/15/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022] Open
|
30
|
Sadeghi-Naini A, Sannachi L, Tadayyon H, Tran WT, Slodkowska E, Trudeau M, Gandhi S, Pritchard K, Kolios MC, Czarnota GJ. Chemotherapy-Response Monitoring of Breast Cancer Patients Using Quantitative Ultrasound-Based Intra-Tumour Heterogeneities. Sci Rep 2017; 7:10352. [PMID: 28871171 PMCID: PMC5583340 DOI: 10.1038/s41598-017-09678-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/28/2017] [Indexed: 12/12/2022] Open
Abstract
Anti-cancer therapies including chemotherapy aim to induce tumour cell death. Cell death introduces alterations in cell morphology and tissue micro-structures that cause measurable changes in tissue echogenicity. This study investigated the effectiveness of quantitative ultrasound (QUS) parametric imaging to characterize intra-tumour heterogeneity and monitor the pathological response of breast cancer to chemotherapy in a large cohort of patients (n = 100). Results demonstrated that QUS imaging can non-invasively monitor pathological response and outcome of breast cancer patients to chemotherapy early following treatment initiation. Specifically, QUS biomarkers quantifying spatial heterogeneities in size, concentration and spacing of acoustic scatterers could predict treatment responses of patients with cross-validated accuracies of 82 ± 0.7%, 86 ± 0.7% and 85 ± 0.9% and areas under the receiver operating characteristic (ROC) curve of 0.75 ± 0.1, 0.80 ± 0.1 and 0.89 ± 0.1 at 1, 4 and 8 weeks after the start of treatment, respectively. The patients classified as responders and non-responders using QUS biomarkers demonstrated significantly different survivals, in good agreement with clinical and pathological endpoints. The results form a basis for using early predictive information on survival-linked patient response to facilitate adapting standard anti-cancer treatments on an individual patient basis.
Collapse
Affiliation(s)
- Ali Sadeghi-Naini
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Lakshmanan Sannachi
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Hadi Tadayyon
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.,Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - William T Tran
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Elzbieta Slodkowska
- Division of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Maureen Trudeau
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sonal Gandhi
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kathleen Pritchard
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Gregory J Czarnota
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada. .,Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
31
|
Lim EA, Gunther JE, Kim HK, Flexman M, Hibshoosh H, Crew K, Taback B, Campbell J, Kalinsky K, Hielscher A, Hershman DL. Diffuse optical tomography changes correlate with residual cancer burden after neoadjuvant chemotherapy in breast cancer patients. Breast Cancer Res Treat 2017; 162:533-540. [PMID: 28190249 DOI: 10.1007/s10549-017-4150-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 02/07/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Breast cancer (BC) patients who achieve a favorable residual cancer burden (RCB) after neoadjuvant chemotherapy (NACT) have an improved recurrence-free survival. Those who have an unfavorable RCB will have gone through months of ineffective chemotherapy. No ideal method exists to predict a favorable RCB early during NACT. Diffuse optical tomography (DOT) is a novel imaging modality that uses near-infrared light to assess hemoglobin concentrations within breast tumors. We hypothesized that the 2-week percent change in DOT-measured hemoglobin concentrations would associate with RCB. METHODS We conducted an observational study of 40 women with stage II-IIIC BC who received standard NACT. DOT imaging was performed at baseline and 2 weeks after treatment initiation. We evaluated the associations between the RCB index (continuous measure), class (categorical 0, I, II, III), and response (RCB class 0/I = favorable, RCB class II/III = unfavorable) with changes in DOT-measured hemoglobin concentrations. RESULTS The RCB index correlated significantly with the 2-week percent change in oxyhemoglobin [HbO2] (r = 0.5, p = 0.003), deoxyhemoglobin [Hb] (r = 0.37, p = 0.03), and total hemoglobin concentrations [HbT] (r = 0.5, p = 0.003). The RCB class and response significantly associated with the 2-week percent change in [HbO2] (p ≤ 0.01) and [HbT] (p ≤ 0.02). [HbT] 2-week percent change had sensitivity, specificity, positive, and negative predictive values for a favorable RCB response of 86.7, 68.4, 68.4, and 86.7%, respectively. CONCLUSION The 2-week percent change in DOT-measured hemoglobin concentrations was associated with the RCB index, class, and response. DOT may help guide NACT for women with BC.
Collapse
Affiliation(s)
- Emerson A Lim
- Division of Hematology/Oncology, Department of Medicine, Columbia University Medical Center, 161 Fort Washington Avenue, 9th Floor, New York, NY, 10032, USA.
| | - Jacqueline E Gunther
- Department of Biomedical Engineering, Columbia University, 500 West 120th Street, 341 Mudd Bldg, New York, NY, 10027, USA
| | - Hyun K Kim
- Department of Radiology, Columbia University, 650 West 168th Street, Black Building, Rm 1727, New York, NY, 10032, USA
| | - Molly Flexman
- Philips Research Americas, 2 Canal Park, 3rd Floor, Cambridge, MA, 02141, USA
| | - Hanina Hibshoosh
- Department of Pathology and Cell Biology, Columbia University Medical Center, 630 West 168th Street, VC 14-215, New York, NY, 10032, USA
| | - Katherine Crew
- Division of Hematology/Oncology, Department of Medicine, Department of Epidemiology, Columbia University Medical Center, 161 Fort Washington Avenue, 10th Floor, New York, NY, 10032, USA
| | - Bret Taback
- Department of Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, 10th Floor, New York, NY, 10032, USA
| | - Jessica Campbell
- Herbert Irving Comprehensive Cancer Center, 161 Fort Washington Avenue, Mezzanine, New York, NY, 10032, USA
| | - Kevin Kalinsky
- Division of Hematology/Oncology, Department of Medicine, Department of Epidemiology, Columbia University Medical Center, 161 Fort Washington Avenue, 10th Floor, New York, NY, 10032, USA
| | - Andreas Hielscher
- Department of Biomedical Engineering, Columbia University, Engineering Terrace 351, Mail Code 8904, New York, NY, 10027, USA
| | - Dawn L Hershman
- Division of Hematology/Oncology, Department of Medicine, Department of Epidemiology, Columbia University Medical Center, 161 Fort Washington Avenue, 10th Floor, New York, NY, 10032, USA
| |
Collapse
|
32
|
Criscitiello C, Curigliano G, Burstein HJ, Wong S, Esposito A, Viale G, Giuliano M, Veronesi U, Santangelo M, Golshan M. Breast conservation following neoadjuvant therapy for breast cancer in the modern era: Are we losing the opportunity? Eur J Surg Oncol 2016; 42:1780-1786. [PMID: 27825710 DOI: 10.1016/j.ejso.2016.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/21/2016] [Accepted: 10/07/2016] [Indexed: 11/18/2022] Open
Abstract
The main rationale for neoadjuvant therapy for breast cancer is to provide effective systemic treatment while surgically down-staging the cancer. This down-staging was initially to convert inoperable patients to operable and later to increase rates of breast conservation in patients initially deemed mastectomy only candidates. Unexpectedly, in recent neoadjuvant trials lower rates of breast conservation have been observed than in past decades, despite remarkable advances in systemic therapies, which have increased pathologic complete response rates. These results point to factors aside from response and eligibility for breast conservation that may lead surgeons and/or patients to recommend and choose mastectomy. Here, we aim to examine the surgical benefits offered by the modern era neoadjuvant therapy and explore factors that have contributed to this decrease in breast conservation rates. If the main benefit of neoadjuvant therapy is to increase the opportunity for breast conservation, then our review suggests that to optimize less invasive surgical approaches, we will need to address both surgeon and patient-level variables and biases that may be limiting our ability to identify patients appropriate for less aggressive options. As an oncology community, we must be aware of the surgical overtreatment of breast cancer, especially in a time where systemic therapies have remarkably improved outcomes and responses.
Collapse
Affiliation(s)
- C Criscitiello
- Division of Experimental Therapeutics, European Institute of Oncology, Via G. Ripamonti 435, Milan, Italy.
| | - G Curigliano
- Division of Experimental Therapeutics, European Institute of Oncology, Via G. Ripamonti 435, Milan, Italy.
| | - H J Burstein
- Department of Breast Oncology Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA.
| | - S Wong
- Department of Surgery, McGill Hospital, Boston, MA, USA.
| | - A Esposito
- Division of Experimental Therapeutics, European Institute of Oncology, Via G. Ripamonti 435, Milan, Italy.
| | - G Viale
- Division of Experimental Therapeutics, European Institute of Oncology, Via G. Ripamonti 435, Milan, Italy.
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University Federico II, Corso Umberto I 40, Naples, Italy.
| | - U Veronesi
- Division of Experimental Therapeutics, European Institute of Oncology, Via G. Ripamonti 435, Milan, Italy.
| | - M Santangelo
- General Surgery, Department of Advanced Biomedical Science, University Federico II, Corso Umberto I 40, Naples, Italy.
| | - M Golshan
- Department of Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.
| |
Collapse
|
33
|
Kim TH, Yoon JK, Kang DK, Kang SY, Jung YS, Han S, Kim JY, Yim H, An YS. Value of volume-based metabolic parameters for predicting survival in breast cancer patients treated with neoadjuvant chemotherapy. Medicine (Baltimore) 2016; 95:e4605. [PMID: 27741099 PMCID: PMC5072926 DOI: 10.1097/md.0000000000004605] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We evaluated the role of metabolic parameters in the prediction of disease recurrence in operable invasive ductal breast cancer patients treated with neoadjuvant chemotherapy (NAC).We retrospectively evaluated 139 female patients (mean age, 46.5 years; range: 27-72 years) with invasive ductal breast cancer, treated with NAC followed by surgery. All patients underwent F-fluorodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging at baseline and after completion of NAC before surgery. The prognostic significance of clinicopathological and imaging parameters for disease-free survival (DFS) was evaluated.Recurrence of cancer was detected in 31 of 139 patients (22.3%; follow-up period: 6-82 months). Baseline maximum standardized uptake value, metabolic tumor volume (MTV), and reduction rate (RR) of MTV after NAC were significant independent prognostic factors for DFS in a multivariate analysis (all P < 0.05). The survival functions differed significantly between low and high histological grades (P < 0.001). DFS of the patients with high baseline MTV (≥5.23 cm) was significantly poorer than that of low MTV patients (P = 0.019). The survival function of the group with low RR of MTV after NAC (≤90.72%) was poorer than the higher RR of the MTV group (P = 0.008).Our findings suggest that breast cancer patients who have a high histological grade, large baseline MTV, or a small RR of MTV after NAC should receive great attention to check for possible recurrence.
Collapse
Affiliation(s)
| | - Joon-Kee Yoon
- Department of Nuclear Medicine and Molecular Imaging
| | | | | | | | | | | | - Hyunee Yim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Sil An
- Department of Nuclear Medicine and Molecular Imaging
- Correspondence: Young-Sil An, Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Ajou University, Woncheon-dong, Yeongtong-gu, Gyeonggi-do, Suwon 443-749, Korea (e-mail: )
| |
Collapse
|
34
|
Liu J, Blake SJ, Yong MCR, Harjunpää H, Ngiow SF, Takeda K, Young A, O'Donnell JS, Allen S, Smyth MJ, Teng MWL. Improved Efficacy of Neoadjuvant Compared to Adjuvant Immunotherapy to Eradicate Metastatic Disease. Cancer Discov 2016; 6:1382-1399. [PMID: 27663893 DOI: 10.1158/2159-8290.cd-16-0577] [Citation(s) in RCA: 540] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 12/17/2022]
Abstract
Immunotherapy has recently entered a renaissance phase with the approval of multiple agents for the treatment of cancer. Immunotherapy stands ready to join traditional modalities, including surgery, chemotherapy, radiation, and hormone therapy, as a pillar of cancer treatment. Although immunotherapy has begun to have success in advanced cancer treatment, its scheduling and efficacy with surgery to treat earlier stages of cancer and prevent distant metastases have not been systematically examined. Here, we have used two models of spontaneously metastatic breast cancers in mice to illustrate the significantly greater therapeutic power of neoadjuvant, compared with adjuvant, immunotherapies in the context of primary tumor resection. Elevated and sustained peripheral tumor-specific immune responses underpinned the outcome, and blood sampling of tumor-specific CD8+ T cells immediately prior to and post surgery may provide a predictor of outcome. These data now provide a strong rationale to extensively test and compare neoadjuvant immunotherapy in humans. SIGNIFICANCE We demonstrate the significantly greater therapeutic efficacy of neoadjuvant, compared with adjuvant, immunotherapies to eradicate distant metastases following primary tumor resection. Elevated and sustained peripheral tumor-specific immune responses underpinned the outcome, and blood sampling of tumor-specific CD8+ T cells immediately prior to and post surgery may provide a predictor of outcome. Cancer Discov; 6(12); 1382-99. ©2016 AACR.See related commentary by Melero et al., p. 1312This article is highlighted in the In This Issue feature, p. 1293.
Collapse
Affiliation(s)
- Jing Liu
- Cancer Immunoregulation and Immunotherapy Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Stephen J Blake
- Cancer Immunoregulation and Immunotherapy Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Michelle C R Yong
- Cancer Immunoregulation and Immunotherapy Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Heidi Harjunpää
- Cancer Immunoregulation and Immunotherapy Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Shin Foong Ngiow
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Kazuyoshi Takeda
- Division of Cell Biology, Biomedical Research Center, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Arabella Young
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Jake S O'Donnell
- Cancer Immunoregulation and Immunotherapy Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Stacey Allen
- Cancer Immunoregulation and Immunotherapy Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Mark J Smyth
- Immunology in Cancer and Infection Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Michele W L Teng
- Cancer Immunoregulation and Immunotherapy Laboratory, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia. .,School of Medicine, University of Queensland, Herston, Queensland, Australia
| |
Collapse
|
35
|
Abstract
The research article by Carey and colleagues, published in the April 15, 2007, issue of Clinical Cancer Research, described the relationship between response to neoadjuvant chemotherapy and outcome by tumor subtype. Today neoadjuvant clinical trials are often designed to provide correlative data to help identify predictive biomarkers or to focus on poor-risk patients identified by residual disease after neoadjuvant treatment.
Collapse
Affiliation(s)
- Lisa A Carey
- The University of North Carolina, Chapel Hill, North Carolina.
| |
Collapse
|
36
|
Herrero-Vicent C, Guerrero-Zotano A, Gavilá-Gregori J, Hernández-Blanquisett A, Sandiego-Contreras S, Samper-Hiraldo JM, Guillem-Porta V, Ruiz-Simón A. A prognostic index for locoregional recurrence after neoadjuvant chemotherapy. Ecancermedicalscience 2016; 10:647. [PMID: 27433280 PMCID: PMC4929976 DOI: 10.3332/ecancer.2016.647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Indexed: 01/03/2023] Open
Abstract
Background The appropriate selection criteria for breast-conserving surgery (BCS) or mastectomy after neoadjuvant chemotherapy (NAC) are poorly defined. The aim of this study is to analyse the incidence and prognostic factors for locoregional recurrence (LRR) in patients with breast cancer (BC) treated with NAC to develop a prognostic score to help with clinical decision-making. Materials and methods Using our retrospective maintained BC database, we identified 730 patients treated with NAC (327 patients treated with BCS and 403 patients treated with mastectomy) between 1998 and 2014. To identify variables associated with an increased LRR rate, we performed firstly Kaplan–Meier curves, with comparisons among groups using log-rank test, and then, significant variables were included in a multivariate analysis using Cox proportional hazards. The prognostic index was developed by assigning score 0 (favourable) or score 1 (unfavourable) for each significant variable of multivariate analysis and was created separately for patients with BCS and mastectomy. Results At a median follow-up of 72 months, the 6-year cumulative incidence of LRR was 7.2% ( ± 3%) for BCS and 7.9% ( ± 3%) for mastectomy. By univariate analysis, variables associated with an increased LRR were for BCS: HER2 positive, grade III, ductal carcinoma in situ (DCIS), No-pCR (ypTis, ypN0), and age < 40 years; and for mastectomy, HER2-positive, DCIS, No-pCR, and LVI. By multivariate analysis, variables associated with an increased LRR were for BCS: HER2 positive (HR: 11.1, p = 0.001), DCIS (HR: 3.1, p = 0.005), and age < 40 years (HR: 2.8, p = 0.02); and for mastectomy: HER2 positive (HR: 9.5, p = 0.03), DCIS (HR: 2.7, p = 0.01), No-pCR (HR: 11.4, p = 0.01), and age < 40 years (HR: 2.8, p = 0.006). The score stratified patients into three subsets with statistically different levels of risk for LRR. For BCS, the six-year LRR rates were 3%, 13%, and 33% for the low (score 0, n = 120), intermediate (score 1, n = 95) and high (score 2–3, n = 27) risk groups, respectively (p = 0.001). For mastectomy, the six-year LRR rates were 0%, 8%, and 27% for the low (score 0, n = 20), intermediate (score 1–2, n 191), and high (score 3–4, n = 30) risk groups, respectively (p = 0.001). Of note, 21 patients that had a LRR event were HER2 positive, all of them had received trastuzumab. Conclusions Patients with a score of 0, which made up to 19% of the study population, had very low risk of LRR. The score enabled the identification of a small group (7%) of patients with very high risk of LRR, and who may benefit from alternative treatment.
Collapse
Affiliation(s)
- C Herrero-Vicent
- Medical Oncology, Valencian Institute of Oncology, Valencia, Spain
| | | | - J Gavilá-Gregori
- Medical Oncology, Valencian Institute of Oncology, Valencia, Spain
| | | | | | | | - V Guillem-Porta
- Medical Oncology, Valencian Institute of Oncology, Valencia, Spain
| | - A Ruiz-Simón
- Medical Oncology, Valencian Institute of Oncology, Valencia, Spain
| |
Collapse
|
37
|
Bouzón A, Acea B, Soler R, Iglesias Á, Santiago P, Mosquera J, Calvo L, Seoane-Pillado T, García A. Diagnostic accuracy of MRI to evaluate tumour response and residual tumour size after neoadjuvant chemotherapy in breast cancer patients. Radiol Oncol 2016; 50:73-9. [PMID: 27069452 PMCID: PMC4825338 DOI: 10.1515/raon-2016-0007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/30/2015] [Indexed: 12/29/2022] Open
Abstract
Background The aim, of the study was to estimate the accuracy of magnetic resonance imaging (MRI) in assessing residual disease in breast cancer patients receiving neoadjuvant chemotherapy (NAC) and to identify the clinico-pathological factors that affect the diagnostic accuracy of breast MRI to determine residual tumour size following NAC. Patients and methods 91 breast cancer patients undergoing NAC (92 breast lesions) were included in the study. Breast MRI was performed at baseline and after completion of NAC. Treatment response was evaluated by MRI and histopathological examination to investigate the ability of MRI to predict tumour response. Residual tumour size was measured on post-treatment MRI and compared with pathology in 89 lesions. Clinicopathological factors were analyzed to compare MRI-pathologic size differences. Results The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosing invasive residual disease by using MRI were 75.00%, 78.57%, 88.89%, 57.89%, and 76.09% respectively. The Pearson’s correlation coefficient (r) between tumour sizes determined by MRI and pathology was r = 0.648 (p < 0.001). The size discrepancy was significantly lower in cancers with initial MRI size ≤ 5 cm (p = 0.050), in cancers with high tumour grade (p < 0.001), and in patients with hormonal receptor-negative cancer (p = 0.033). Conclusions MRI is an accurate tool for evaluating tumour response after NAC. The accuracy of MRI in estimating residual tumour size varies with the baseline MRI tumour size, the tumour grade and the hormonal receptor status.
Collapse
Affiliation(s)
- Alberto Bouzón
- Department of Surgery; Breast Unit. Complexo Hospitalario Universitario de A Coruña Sergas, Spain
| | - Benigno Acea
- Department of Surgery; Breast Unit. Complexo Hospitalario Universitario de A Coruña Sergas, Spain
| | - Rafaela Soler
- Department of Radiology, Breast Unit. Complexo Hospitalario Universitario de A Coruña Sergas, Spain
| | - Ángela Iglesias
- Department of Radiology, Breast Unit. Complexo Hospitalario Universitario de A Coruña Sergas, Spain
| | - Paz Santiago
- Department of Anatomic Pathology, Breast Unit. Complexo Hospitalario Universitario de A Coruña Sergas, Spain
| | - Joaquín Mosquera
- Department of Radiology, Breast Unit. Complexo Hospitalario Universitario de A Coruña Sergas, Spain
| | - Lourdes Calvo
- Department of Clinical Oncology, Breast Unit. Complexo Hospitalario Universitario de A Coruña Sergas, Spain
| | - Teresa Seoane-Pillado
- Clinical Epidemiology and Biostatistics Unit, Breast Unit. Complexo Hospitalario Universitario de A Coruña Sergas, Spain
| | - Alejandra García
- Department of Surgery; Breast Unit. Complexo Hospitalario Universitario de A Coruña Sergas, Spain
| |
Collapse
|
38
|
Dhanraj KM, Dubashi B, Gollapalli S, Kayal S, Cyriac SL. Comparison of efficacy of neoadjuvant chemotherapy FEC 100 and Docetaxel 75 versus AC and Docetaxel in locally advanced breast cancer: a randomized clinical study. Med Oncol 2015; 32:261. [PMID: 26520144 DOI: 10.1007/s12032-015-0697-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
The aim of the study was to assess and compare the clinical and pathological response and the toxicity profile between neoadjuvant chemotherapy FEC followed by docetaxel versus AC followed by docetaxel in locally advanced breast cancer patients. Between June 2013 and June 2014, 148 patients diagnosed with LABC were randomized into two groups with 74 in each group. Group 1 received AC (adriamycin 60 mg/m(2), cyclophosphamide 600 mg/m(2)) followed by docetaxel 100 mg/m(2) with primary GCSF prophylaxis and group 2 received FEC (5-fluorouracil 500 mg/m(2), epirubicin 100 mg/m(2), cyclophosphamide 500 mg/m(2)) followed by docetaxel 75 mg/m(2). MRM/BCS was performed for all patients after NACT and assessed for pathological response. Toxicity profile was assessed according to CTCAE version 4. All baseline parameters were equally matched between the two regimens. 90 % of patients completed NACT and underwent surgery. pCR rates were 31 % in group 1 and 34 % in group 2 without any difference. Any grade of hand-foot syndrome was significantly high in group 1 as compared to group 2. Grade 3 and grade 4 neutropenia and febrile neutropenia were significantly high in group 1 as compared to group 2. Median follow-up was 13.7 months (range, 2.9-25 months). There was no difference in the 2-year PFS between group 1 and group 2 (70.9 vs. 73.8 %, respectively) and OS (87.8 vs. 91.8 %, respectively) in our study population. Chemotherapy with FEC followed by docetaxel can be considered as an optimal neoadjuvant regimen in LABC as compared to AC followed by docetaxel.
Collapse
Affiliation(s)
- K M Dhanraj
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | - B Dubashi
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | - S Gollapalli
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | - S Kayal
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | - Sunu Lazar Cyriac
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| |
Collapse
|
39
|
Impact of neoadjuvant chemotherapy in stage II-III triple negative breast cancer on eligibility for breast-conserving surgery and breast conservation rates: surgical results from CALGB 40603 (Alliance). Ann Surg 2015. [PMID: 26222764 DOI: 10.1097/sla.0000000000001417] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the efficacy of neoadjuvant systemic therapy (NST) at increasing the rate of successful breast-conserving therapy (BCT) in triple negative breast cancer. BACKGROUND Inducing tumor regression to permit BCT is often cited to support administration of NST. To quantify this benefit, we conducted a surgical companion study to CALGB40603, a randomized phase II, 2×2 factorial trial of neoadjuvant paclitaxel ± carboplatin ± bevacizumab (B) followed by doxorubicin plus cyclophosphamide ± B in stage II-III triple negative breast cancer. METHODS Before and after NST, treating surgeons evaluated BCT candidacy by clinico-radiographic criteria; surgery performed was at surgeon and patient discretion. We measured (1) conversion rates from BCT-ineligible to BCT-eligible, (2) surgical choices in BCT candidates, and (3) rates of successful BCT with tumor-free margins. RESULTS Four hundred four patients were assessable for surgical outcomes. Two hundred nineteen (54%) were BCT candidates before NST. One hundred ninety-seven (90%) remained BCT candidates after NST, of whom 138 (70%) chose BCT, which was successful in 130 (94%). Of 185 (46%) who were not BCT candidates before NST, 78 (42%) converted to candidates with NST. Of these, 53 (68%) chose BCT with a 91% (48/53) success rate. The overall BCT-eligibility rate rose from 54% to 68% (275/404) with NST. Addition of carboplatin, B, or both increased conversion rates. CONCLUSIONS This is the first study to document prospectively a 42% conversion rate from BCT-ineligible to BCT-eligible, resulting in a 14% absolute increase in BCT eligibility. BCT was successful in 93% of patients who opted for it, but 31% of BCT-eligible patients still chose mastectomy.
Collapse
|
40
|
Mak KS, Harris JR. Radiotherapy Issues After Neoadjuvant Chemotherapy. J Natl Cancer Inst Monogr 2015; 2015:87-9. [DOI: 10.1093/jncimonographs/lgv003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
41
|
Erbes T, Orlowska-Volk M, Zur Hausen A, Rücker G, Mayer S, Voigt M, Farthmann J, Iborra S, Hirschfeld M, Meyer PT, Gitsch G, Stickeler E. Neoadjuvant chemotherapy in breast cancer significantly reduces number of yielded lymph nodes by axillary dissection. BMC Cancer 2014; 14:4. [PMID: 24386929 PMCID: PMC3884010 DOI: 10.1186/1471-2407-14-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/30/2013] [Indexed: 11/21/2022] Open
Abstract
Background Neoadjuvant chemotherapy (NC) is an established therapy in breast cancer, able to downstage positive axillary lymph nodes, but might hamper their detectibility. Even if clinical observations suggest lower lymph node yield (LNY) after NC, data are inconclusive and it is unclear whether NC dependent parameters influence detection rates by axillary lymph node dissection (ALND). Methods We analyzed retrospectively the LNY in 182 patients with ALND after NC and 351 patients with primary ALND. Impact of surgery or pathological examination and specific histomorphological alterations were evaluated. Outcome analyses regarding recurrence rates, disease free (DFS) and overall survival (OS) were performed. Results Axillary LNY was significantly lower in the NC in comparison to the primary surgery group (median 13 vs. 16; p < 0.0001). The likelihood of incomplete axillary staging was four times higher in the NC group (14.8% vs. 3.4%, p < 0.0001). Multivariate analyses excluded any influence by surgeon or pathologist. However, the chemotherapy dependent histological feature lymphoid depletion was an independent predictive factor for a lower LNY. Outcome analyses revealed no significant impact of the LNY on local and regional recurrence rates as well as DFS and OS, respectively. Conclusion NC significantly reduces the LNY by ALND and has profound effects on the histomorphological appearance of lymph nodes. The current recommendations for a minimum removal of 10 lymph nodes by ALND are clearly compromised by the clinically already established concept of NC. The LNY of less than 10 by ALND after NC might not be indicative for an insufficient axillary staging.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Elmar Stickeler
- Department of Gynaecology and Obstetrics, University Medical Center Freiburg, Hugstetter Street 55, 79106 Freiburg, Germany.
| |
Collapse
|
42
|
Quantitative assessment Ki-67 score for prediction of response to neoadjuvant chemotherapy in breast cancer. J Transl Med 2014; 94:98-106. [PMID: 24189270 DOI: 10.1038/labinvest.2013.128] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 12/20/2022] Open
Abstract
Measurement of Ki-67, a marker of cell proliferation, has been associated with response to therapy, but methods of measurement are controversial. Here we use a quantitative objective measurement for Ki-67 to determine the best method for assessment of Ki-67 for prediction of response to neoadjuvant chemotherapy. Analysis was conducted on a cohort of 105 consecutive invasive breast cancer patients that received neoadjuvant therapy between 2002 and 2010, and on whom pre-surgical biopsies were obtainable. Ki-67 expression was measured using quantitative immunofluorescence automated quantitative analysis (AQUA) technology. Images for each specimen were collected for 5 to 115 fields of view (FOVs) and summary scores were obtained, corresponding to the average and maximum of all the FOVs. AQUA scoring (using both intensity and area) was comparable to automated calculation of percentage of positive nuclei for prediction of response to chemotherapy (OR: 2.832 vs 2.712). Both the average and maximum AQUA score showed Ki-67 expression was directly correlated to pathological complete response (pCR; average P=0.0002; maximum P=0.0011). Although examining the maximum FOV was more predictive of response to therapy (OR: 3.546 vs 2.832), averaging all fields provided more sensitivity and specificity (AUC 0.769 vs 0.732). Ki-67 average (P=0.0025) and maximum (P=0.0239) AQUA score were also significant predictors of pCR in a multivariable analysis, including tumor size, nuclear grade, nodal status, ER status, and HER2 status. Measurement of Ki-67 expression by objective quantitative methods shows increased Ki-67 levels are an independent predictor of response to neoadjuvant chemotherapy.
Collapse
|
43
|
|
44
|
Mukai H, Watanabe T, Mitsumori M, Tsuda H, Nakamura S, Masuda N, Yamamoto N, Shibata T, Sato A, Iwata H, Aogi K. Final results of a safety and efficacy trial of preoperative sequential chemoradiation therapy for the nonsurgical treatment of early breast cancer: Japan Clinical Oncology Group Study JCOG0306. Oncology 2013; 85:336-41. [PMID: 24247597 DOI: 10.1159/000355196] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 08/16/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the possibility of nonsurgical treatment of primary breast cancers by a sequential treatment of chemotherapy and radiotherapy. METHODS We conducted a safety and efficacy trial of chemotherapy and radiation therapy sequentially as primary therapy in patients with stage I-IIIA breast cancer. All patients underwent mastectomy or lumpectomy 12-16 weeks after the completion of radiation therapy to maximize the effect of radiation therapy. The primary endpoint was the pathological complete response (pCR) rate. RESULTS Between June 2004 and April 2005, one hundred eight patients were enrolled. Thirty six percent of the entire population achieved a pCR, which could not reject the null hypothesis. The pCR rate was 57% in patients with hormone receptor (HR)-negative/HER-2-positive tumors and 52% in patients with triple-negative tumors. While 7% of the HR-negative/HER2-positive patients recurred, a higher incidence of recurrence (24%) was observed in triple-negative tumors in a follow-up of 4.5 years. The rate of breast-conserving surgery was 88.9% (96/108). CONCLUSION The pCR rate was not high enough, even though preoperative sequential chemoradiation therapy did not increase the risk of operative complications and could achieve a high rate of breast-conserving surgery.
Collapse
|
45
|
Gampenrieder SP, Rinnerthaler G, Greil R. Neoadjuvant chemotherapy and targeted therapy in breast cancer: past, present, and future. JOURNAL OF ONCOLOGY 2013; 2013:732047. [PMID: 24027583 PMCID: PMC3762209 DOI: 10.1155/2013/732047] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 07/11/2013] [Indexed: 11/21/2022]
Abstract
Traditionally, neoadjuvant treatment for breast cancer was preserved for locally advanced and inflammatory disease, converting an inoperable to a surgical resectable cancer. In recent years, neoadjuvant therapy has become an accepted treatment option also for lower tumor stages in order to increase the rate of breast conserving therapy and to reduce the extent of surgery. Furthermore, treatment response can be monitored, and therefore, patient compliance may be increased. Neoadjuvant trials, additionally, offer the opportunity to evaluate new treatment options in a faster way and with fewer patients than large adjuvant trials. Compared to the metastatic setting, the issue of acquired resistance and pretreatments, which may distort treatment efficacy, can be avoided. New trial designs like window-of-opportunity trials or postneoadjuvant trials provide the chance to identify tumor sensitivity or to overcome tumor resistance in early tumor stages. In particular, in HER2-positive breast cancer, the neoadjuvant approach yielded great successes. The dual HER2 blockade with trastuzumab and pertuzumab recently showed the highest pCR rates ever reported. Many new drugs are in clinical testing with the aim to further increase pCR rates. Whether this endpoint really represents a surrogate for long-term outcome is not answered yet and will be discussed in this review.
Collapse
Affiliation(s)
- Simon P. Gampenrieder
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Laboratory of Immunological and Molecular Cancer Research, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Gabriel Rinnerthaler
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Laboratory of Immunological and Molecular Cancer Research, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Richard Greil
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Laboratory of Immunological and Molecular Cancer Research, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| |
Collapse
|
46
|
The Impact of Neoadjuvant Chemotherapy on Local-Regional Treatment of Breast Cancer. CURRENT BREAST CANCER REPORTS 2013. [DOI: 10.1007/s12609-013-0106-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
47
|
Dabakuyo T, Arnaud A, Maingon P, Causeret S, Coudert B, Fumoleau P, Arnould L, Poillot ML, Arveux P, Crehange G, Bonnetain F. Impact of neoadjuvant chemotherapy on survival in breast cancer patients in daily practice: a population-based study. Eur J Cancer Care (Engl) 2013; 22:638-47. [DOI: 10.1111/ecc.12069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2013] [Indexed: 11/26/2022]
Affiliation(s)
| | - A. Arnaud
- Radiotherapy Department; Centre Georges François Leclerc; Dijon
| | - P. Maingon
- Radiotherapy Department; Centre Georges François Leclerc; Dijon
| | - S. Causeret
- Surgery Department; Centre Georges François Leclerc; Dijon
| | - B. Coudert
- Oncology Department; Centre Georges François Leclerc; Dijon
| | - P. Fumoleau
- Oncology Department; Centre Georges François Leclerc; Dijon
| | - L. Arnould
- Anatomopathology Department; Centre Georges François Leclerc; Dijon
| | | | | | - G. Crehange
- Radiotherapy Department; Centre Georges François Leclerc; Dijon
| | - F. Bonnetain
- Methodological and Quality of Life Unit in Oncology (EA3181); University Hospital; Besançon; France
| |
Collapse
|
48
|
The role of the breast cancer surgeon in personalized cancer care: clinical utility of the 21-gene assay. Am J Surg 2012; 203:751-8. [DOI: 10.1016/j.amjsurg.2011.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/19/2011] [Accepted: 07/19/2011] [Indexed: 01/12/2023]
|
49
|
Massabeau C, Sigal-Zafrani B, Belin L, Savignoni A, Richardson M, Kirova YM, Cohen-Jonathan-Moyal E, Mégnin-Chanet F, Hall J, Fourquet A. The fibroblast growth factor receptor 1 (FGFR1), a marker of response to chemoradiotherapy in breast cancer? Breast Cancer Res Treat 2012; 134:259-66. [DOI: 10.1007/s10549-012-2027-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 03/08/2012] [Indexed: 11/25/2022]
|
50
|
Bates T, Williams NJ, Bendall S, Bassett EE, Coltart RS. Primary chemo-radiotherapy in the treatment of locally advanced and inflammatory breast cancer. Breast 2012; 21:330-5. [PMID: 22410111 DOI: 10.1016/j.breast.2012.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 01/12/2012] [Accepted: 02/05/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The best management of large, diffuse or inflammatory breast cancers is uncertain and the place of radiotherapy and/or surgery is not clearly defined. METHODS A cohort of 123 patients with non-metastatic locally advanced or inflammatory breast cancer 3 cm or more in diameter or T4, was treated between 1989 and 2006. All patients received primary chemotherapy followed by radiotherapy, 40 Gy in 15 fractions with 10 Gy boost. Patients with ER positive tumours received Tamoxifen. Assessment was carried out 8 weeks post-treatment and surgery was reserved for residual or recurrent disease. RESULTS For each stage there were T2/3: 63, T4b: 31 and T4d: 29 patients. 80 had complete clinical response (65%) but 18 patients were never free of inoperable local disease. 25 patients had residual operable disease at assessment and 12 patients who initially had a complete response developed operable local recurrence (LR). 37 Patients (30%) had surgery at a mean of 15 months post diagnosis. At 5 years, overall survival (OS) of the two surgical groups was not significantly different from those 68 patients who had complete remission without surgery, p=0.218, HR 1.46 (0.80-2.55). Surgery as an independent variable to predict survival was not significant on a Cox proportional hazards model (p=0.97). LR in the surgical groups was 13.5% vs 17.5% in the non-surgical patients. The median OS was 64.5 months and disease-free survival (DFS) was 52.5 months. 5-Year OS was 54% and DFS survival 43%. CONCLUSION In patients with a complete or partial response to chemo-radiotherapy for locally advanced or inflammatory breast cancer, reserving surgery for those with residual or recurrent local disease did not appear to compromise survival. This finding would support examination of this treatment strategy by a randomised controlled trial.
Collapse
Affiliation(s)
- Tom Bates
- The Breast Unit, William Harvey Hospital, Ashford, Kent TN24 OLZ, UK
| | | | | | | | | |
Collapse
|