Neoadjuvant FEC 100 for Operable Breast Cancer: Eight-Year Experience at Centre Jean Perrin

A nomogram for predicting pathological complete response in patients with human epidermal growth factor receptor 2 negative breast cancer

Background

The response to neoadjuvant chemotherapy has been proven to predict long-term clinical benefits for patients. Our research is to construct a nomogram to predict pathological complete response of human epidermal growth factor receptor 2 negative breast cancer patients.

Methods

We enrolled 815 patients who received neoadjuvant chemotherapy from 2003 to 2015 and divided them into a training set and a validation set. Univariate logistic regression was performed to screen for predictors and construct the nomogram; multivariate logistic regression was performed to identify independent predictors.

Results

After performing the univariate logistic regression analysis in the training set, tumor size, hormone receptor status, regimens of neoadjuvant chemotherapy and cycles of neoadjuvant chemotherapy were the final predictors for the construction of the nomogram. The multivariate logistic regression analysis demonstrated that T4 status, hormone receptor status and receiving regimen of paclitaxel and carboplatin were independent predictors of pathological complete response. The area under the receiver operating characteristic curve of the training set and the validation set was 0.779 and 0.701, respectively.

Conclusions

We constructed and validated a nomogram to predict pathological complete response in human epidermal growth factor receptor 2 negative breast cancer patients. We also identified tumor size, hormone receptor status and paclitaxel and carboplatin regimen as independent predictors of pathological complete response.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-016-2652-z) contains supplementary material, which is available to authorized users.

Phase I/II trial of neoadjuvant sunitinib administered with weekly paclitaxel/carboplatin in patients with locally advanced triple-negative breast cancer

The purpose of the study is to evaluate the feasibility and efficacy of adding sunitinib to paclitaxel/carboplatin in the neoadjuvant therapy of patients with triple-negative breast cancer (TNBC). Patients had histologically proven, previously untreated, triple-negative adenocarcinoma, with disease limited to the breast and axilla (clinical T1-T3, N0-N2, M0; T1N1M0 excluded). Following determination of the maximum tolerated doses in the phase I portion, patients in the phase II study received paclitaxel 70 mg/m(2) IV days 1, 8, and 15; carboplatin AUC 5.0 IV day 1; sunitinib 25 mg orally daily; treatment was administered for six 28-day cycles followed by definitive surgery. Sunitinib was resumed postoperatively to complete a 52-week course. Pathologic complete response (pCR) rate was the primary endpoint. Fifty-four patients enrolled; 41 received treatment in the phase II study. Sixteen patients (39 %) were able to complete six cycles of neoadjuvant therapy; 18 additional patients had surgery after completing 2-5 cycles of treatment. The pCR rate in these 34 evaluable patients was 35 %. The toxicity of the regimen was considerable, with myelosuppression resulting in numerous dose reductions and/or omissions of paclitaxel and carboplatin. Eleven patients (27 %) discontinued sunitinib during neoadjuvant therapy, and six patients (14 %) completed 52 weeks of single-agent sunitinib. In the neoadjuvant treatment of patients with TNBC, the combination of paclitaxel, carboplatin, and sunitinib was difficult to administer, and produced a pCR rate comparable to other less toxic regimens. This combination is not recommended for further evaluation. At present, sunitinib has no defined role in the treatment of breast cancer.

Correlation of ultrasound findings with histology, tumor grade, and biological markers in breast cancer

BACKGROUND AND PURPOSE

Ultrasound has been used successfully to differentiate benign and malignant breast lesions. The aim of this study was to investigate the correlation between ultrasound and prognostic indicators in breast cancer such as histological type, tumor grade, and biological markers.

MATERIALS AND METHODS

Ultrasound findings (shape, margin, orientation, boundary, echo pattern, posterior acoustic feature, and presence of calcifications) of 458 breast cancers were analyzed and correlated with the tumor type, tumor grade, and biological markers by univariate and multivariate logistic regression analyses. The biological markers were estrogen receptor, progesterone receptor, and HER-2/neu.

RESULTS

Invasive cancers displayed more frequently an irregular shape, a not parallel orientation, and a hypoechoic or complex echo pattern than carcinoma in situ cases (p < 0.05). Poorly differentiated invasive cancers had more frequently not circumscribed margins, an abrupt boundary, and a hypoechoic or complex echo pattern than moderately/well differentiated cancers (p < 0.05). Estrogen or progesterone receptor negative cancers more often displayed a hypoechoic or complex echo pattern and HER-2/neu positive cancers had more calcifications (p < 0.05).

CONCLUSION

Ultrasound pattern is correlated with tumor type, tumor grade, and biological markers in breast cancers and it may be useful for prediction of prognosis.

Study of COX-2, Ki67, and p53 expression to predict effectiveness of 5-flurouracil, epirubicin and cyclophosphamide with celecoxib treatment in breast cancer patients

BACKGROUND

Cyclooxygenase-2 (COX-2) affects cell proliferation, apoptosis, and metastasis of breast cancer, and may also be involved in tumor angiogenesis through vascular endothelial growth factor. Ki67 and p53 are common markers of proliferation and apoptosis in tumor cells. This study investigated the change in expression of COX-2, Ki67, and p53 in solid tumors after the administration of chemotherapeutic drugs.

MATERIALS AND METHODS

Fifty patients were eligible to be treated with preoperative 5-fluorouracil, epirubicin, and cyclophosphamide, with celecoxib (FECC). Tumor tissue samples from 10 patients who, diagnosed with invasive ductal carcinoma, completed chemotherapy were examined immunohistochemically for COX-2, Ki67, and p53.

RESULTS

From the 60% of patients who expressed COX-2 and 90% who expressed Ki67 and p53 before treatment, 90% of patients revealed a lower intensity staining for each marker after FECC treatment. However, changes in expression of the three markers did not significantly correlate with tumor size, grade, axillary lymph node status. Immunostained slides clearly showed that the diaminobenzidine intensity was markedly reduced after the three-cycle FECC treatment, which implied the combined regimens be effective to the cancer patients.

CONCLUSIONS

This study demonstrates a novel relationship between COX-2, Ki67, and p53 expression of human breast invasive ductal carcinomas. This functional relationship provides support for a potential therapeutic role of COX-2 inhibitors in human breast cancer.