1
|
Yamaguchi A, Kawaguchi K, Kawanishi K, Maeshima Y, Nakakura A, Kataoka TR, Takahara S, Nakagawa S, Yonezawa A, Takada M, Kawashima M, Kawaguchi-Sakita N, Kotake T, Suzuki E, Shimizu H, Torii M, Morita S, Ishiguro H, Toi M. Comparison of cisplatin-based versus standard preoperative chemotherapy in patients with operable triple-negative breast cancer: propensity score matching and inverse probability of treatment weighting analysis. Breast Cancer Res Treat 2024; 204:261-275. [PMID: 38123790 PMCID: PMC10948496 DOI: 10.1007/s10549-023-07163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/12/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE The efficacy of carboplatin is non-equivalent to that of cisplatin (CDDP) for various tumor types in curative settings. However, the role of CDDP in operable triple-negative breast cancer (TNBC) patients remains unknown. We conducted a multicenter observational study to examine the effects of CDDP added to preoperative chemotherapy in patients with TNBC. METHODS This retrospective study consecutively included previously untreated patients with stage I-III TNBC treated with preoperative chemotherapy with or without CDDP. The primary endpoint was distant disease-free survival (DDFS). Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to minimize confounding biases in comparisons between the two groups. RESULTS A total of 138 patients were enrolled in the study. Of these, 52 were in the CDDP group and 86 in the non-CDDP group. DDFS was significantly better in the CDDP group than in the non-CDDP group (unadjusted hazard ratio (HR) 0.127 and p < 0.001, PSM HR 0.141 and p < 0.003, IPTW HR 0.123 and p = < 0.001). Furthermore, among the patients with residual cancer burden (RCB) class II/III, DDFS was better in the CDDP group than in the non-CDDP group (unadjusted HR 0.192 and p = 0.013, PSM HR 0.237 and p = 0.051, IPTW HR 0.124 and p = 0.059). CONCLUSION Our study showed that CDDP-containing regimens achieved favorable prognoses in patients with operable TNBC, especially for the RCB class II/III population. Confirmative studies are warranted to elucidate the role of CDDP in TNBC treatment.
Collapse
Affiliation(s)
- Ayane Yamaguchi
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Kosuke Kawaguchi
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Kana Kawanishi
- Department of Breast Surgery, Kobe City Nishi-Kobe Medical Center, 5-7-1, Kojidai, Nishi-Ku, Kobe, 651-2273, Japan
| | - Yurina Maeshima
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Akiyoshi Nakakura
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Tatsuki R Kataoka
- Department of Molecular Diagnostic Pathology, Iwate Medical University, 1-1-1 Idaidori, Yahaba-Cho, Shiwa-Gun, Iwate, 028-3694, Japan
| | - Sachiko Takahara
- Department of Breast Surgery, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Shunsaku Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Atsushi Yonezawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Masahiro Takada
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Masahiro Kawashima
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Nobuko Kawaguchi-Sakita
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Takeshi Kotake
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Eiji Suzuki
- Department of Breast Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-Cho, Chuo-Ku, Kobe, 650-0047, Japan
| | - Hanako Shimizu
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Masae Torii
- Department of Breast Surgery, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-Dori, Wakayama City, 640-8558, Japan
| | - Satoshi Morita
- Department of Breast Surgery, Kobe City Nishi-Kobe Medical Center, 5-7-1, Kojidai, Nishi-Ku, Kobe, 651-2273, Japan
| | - Hiroshi Ishiguro
- Breast Oncology Service, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Masakazu Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| |
Collapse
|
2
|
Pham HK, Le TD, Nguyen TPH, Le TU, Ta HHD, Nguyen VC. Assessment of residual cancer burden and survival in neoadjuvant chemotherapy of inoperable stage III breast cancer: A ten-year follow-up analysis in Vietnam. Pathol Res Pract 2024; 254:155099. [PMID: 38244433 DOI: 10.1016/j.prp.2024.155099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Prognostic scores such as Residual Cancer Burden (RCB), Clinical Pathological Score (CPS), and Neo-Bioscore have been introduced to categorize breast cancer patients into different prognostic risk groups after neoadjuvant chemotherapy (NAC). PURPOSE To evaluate the prognostic value of the residual cancer burden index in a large group of Vietnamese breast cancer patients treated with neoadjuvant chemotherapy in real-world settings. METHODS 126 patients diagnosed with stage III breast cancer received neoadjuvant chemotherapy according to the AP regimes. After operation of BC, pathologic complete response (pCR) and Residual cancer burden (RCB) were evaluated. All breast cancer patients' survival were analyzed by using Kaplan-Meier and Log-Rank models. RESULTS The average overall survival (OS) time was 75 months, with 90 (71.4%) recurrence and 82 (65%) mortality. The Kaplan Meier curve between OS and DFS with subgroups RCB indicate that the groups with higher RCB had a lower probability of survival, with statistical significance. Adjusted Cox regression model for age, menstruation, side of breast, clinical respose and overall stage illustrate that patients in RCB group 3 had a 2.7 times higher risk of mortality (95% CI: 1.28-5.67) compared to RCB group 0, p = 0.01. Patients with higher RCB levels had a higher risk of mortality. CONCLUSION Stage IIIC, RCB score and RCB group are the independent prognostic factors for predicting survival time of breast cancer patients receiving neoadjuvant treatment.
Collapse
Affiliation(s)
| | | | | | | | | | - Van-Chu Nguyen
- National Cancer Hospital, Vietnam; Hanoi Medical University, Vietnam.
| |
Collapse
|
3
|
Xu X, Zhao W, Liu C, Gao Y, Chen D, Wu M, Li C, Wang X, Song X, Yu J, Liu Z, Yu Z. The residual cancer burden index as a valid prognostic indicator in breast cancer after neoadjuvant chemotherapy. BMC Cancer 2024; 24:13. [PMID: 38166846 PMCID: PMC10762907 DOI: 10.1186/s12885-023-11719-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE The residual cancer burden index (RCB) was proposed as a response evaluation criterion in breast cancer patients treated with Neoadjuvant Chemotherapy (NAC). This study evaluated the relevance of RCB with replase-free survival (RFS). METHODS The clinical data of 254 breast cancer patients who received NAC between 2016 and 2020 were retrospectively collected. The relationship between clinicopathologic factors and RFS was evaluated using Cox proportional hazards regression models. RFS estimates were determined by Kaplan-Meier(K-M) analysis and compared using the log-rank test. Multivariate logistic regression analysis was used to evaluate the risk factors associated with RCB. Receiver operating characteristic (ROC) curves showed the potential of the RCB and MP grading systems as biomarkers for RFS. RESULTS At a median follow-up of 52 months, 59 patients(23.23%) developed relapse. Multivariate Cox regression showed that older age (P = 0.022), high Pathologic T stage after NAC (P = 0.023) and a high RCB score(P = 0.003) were risk factors for relapse. The outcomes of the multivariate logistic analysis indicated that RCB 0 (pathologic complete response [pCR]) was associated with HER2-positive patients (P = 0.002) and triple-negative breast cancer (TNBC) patients (P = 0.013). In addition, the RCB and MP scoring systems served as prognostic markers for patients who received NAC, and their area under curves (AUCs) were 0.691 and 0.342, respectively. CONCLUSION These data suggest that RCB can be equally applied to predict RFS in Chinese patients with NAC. The application of RCB may help guide the selection of treatment strategies.
Collapse
Affiliation(s)
- Xin Xu
- Tianjin Medical University Cancer Institute & Hospital,National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300000, China
- Departments of Oncology, The Second Affiliated Hospital of Shandong First Medical University, Shandong Province, Tai'an, 271000, China
| | - Wei Zhao
- Affiliated Hospital of Jining Medical University, Jining, 272060, China
| | - Cuicui Liu
- Liaocheng People's Hospital, Liaocheng, China
| | - Yongsheng Gao
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People's Republic of China
| | - Dawei Chen
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People's Republic of China
| | - Meng Wu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People's Republic of China
| | - Chao Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People's Republic of China
| | - Xinzhao Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People's Republic of China
| | - Xiang Song
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People's Republic of China
| | - Jinming Yu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People's Republic of China
| | - Zhaoyun Liu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People's Republic of China.
| | - Zhiyong Yu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People's Republic of China.
| |
Collapse
|
4
|
Go J, Ahn JH, Park JM, Choi SB, Kim JY, Park HS, Kim SI, Park BW, Park S. Distinct Prognosis of Minimal Residual Disease According to Breast Cancer Subtype in Patients with Breast or Nodal Pathologic Complete Response After Neoadjuvant Chemotherapy. Ann Surg Oncol 2023; 30:7060-7068. [PMID: 37537485 DOI: 10.1245/s10434-023-13938-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/27/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Few studies have reported on patient prognosis according to residual cancer burden after neoadjuvant chemotherapy (NAC). Herein, we evaluated the survival of patients based on residual disease after NAC to identify subpopulations with distinct prognoses. METHODS We retrospectively reviewed 728 patients treated with NAC from 2010 to 2017. Patients were divided into four subgroups depending on post-surgical residual disease according to the staging system: pathological complete response (pCR) (ypT0/TisN0), minimal residual disease (MRD) (ypT1mi/T1aN0 or ypT0/Tis ypN0i+/N1mic), node-only pCR (≥ ypT1b ypN0), and breast-only pCR (ypT0/Tis ≥ ypN1a). Clinicopathological characteristics and survival outcomes were analyzed by adjusting for factors affecting survival. RESULTS Overall, 50.4% (n = 367) of patients achieved pCR, with the MRD group accounting for 16.5% (n = 120). Although age and clinical stage were not different among the study groups, histologic grade, subtypes, chemotherapy response, and local treatment showed differences. Event-free survival (EFS) and overall survival (OS) demonstrated no significant difference between the pCR and MRD groups. In the multivariate analysis, pCR status was the only significant factor in EFS, and no statistical difference was noted between the pCR and MRD groups. However, clinical stage, pCR status, and subtype significantly affected the OS. MRD showed favorable outcomes in terms of both EFS and OS in all subtypes, except for those with triple-negative breast cancer (TNBC). CONCLUSION Patients with MRD showed outcomes comparable to those of patients who achieved pCR and may be candidates for de-escalation of post-NAC treatment, except for those with a TNBC subtype.
Collapse
Affiliation(s)
- Jieon Go
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Hyun Ahn
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Min Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soon Bo Choi
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Ye Kim
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung Seok Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Il Kim
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byeong-Woo Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seho Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
5
|
Magbanua MJM, van ‘t Veer L, Clark AS, Chien AJ, Boughey JC, Han HS, Wallace A, Beckwith H, Liu MC, Yau C, Wileyto EP, Ordonez A, Solanki T, Hsiao F, Lee JC, Basu A, Swigart LB, Perlmutter J, Delson AL, Bayne L, Deluca S, Yee SS, Carpenter EL, Esserman LJ, Park JW, Chodosh LA, DeMichele A. Outcomes and clinicopathologic characteristics associated with disseminated tumor cells in bone marrow after neoadjuvant chemotherapy in high-risk early stage breast cancer: the I-SPY SURMOUNT study. Breast Cancer Res Treat 2023; 198:383-390. [PMID: 36689092 PMCID: PMC10290540 DOI: 10.1007/s10549-022-06803-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/03/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Disseminated tumor cells (DTCs) expressing epithelial markers in the bone marrow are associated with recurrence and death, but little is known about risk factors predicting their occurrence. We detected EPCAM+/CD45- cells in bone marrow from early stage breast cancer patients after neoadjuvant chemotherapy (NAC) in the I-SPY 2 Trial and examined clinicopathologic factors and outcomes. METHODS Patients who signed consent for SURMOUNT, a sub-study of the I-SPY 2 Trial (NCT01042379), had bone marrow collected after NAC at the time of surgery. EPCAM+CD45- cells in 4 mLs of bone marrow aspirate were enumerated using immunomagnetic enrichment/flow cytometry (IE/FC). Patients with > 4.16 EPCAM+CD45- cells per mL of bone marrow were classified as DTC-positive. Tumor response was assessed using the residual cancer burden (RCB), a standardized approach to quantitate the extent of residual invasive cancer present in the breast and the axillary lymph nodes after NAC. Association of DTC-positivity with clinicopathologic variables and survival was examined. RESULTS A total of 73 patients were enrolled, 51 of whom had successful EPCAM+CD45- cell enumeration. Twenty-four of 51 (47.1%) were DTC-positive. The DTC-positivity rate was similar across receptor subtypes, but DTC-positive patients were significantly younger (p = 0.0239) and had larger pretreatment tumors compared to DTC-negative patients (p = 0.0319). Twenty of 51 (39.2%) achieved a pathologic complete response (pCR). While DTC-positivity was not associated with achieving pCR, it was significantly associated with higher RCB class (RCB-II/III, 62.5% vs. RCB-0/I; 33.3%; Chi-squared p = 0.0373). No significant correlation was observed between DTC-positivity and distant recurrence-free survival (p = 0.38, median follow-up = 3.2 years). CONCLUSION DTC-positivity at surgery after NAC was higher in younger patients, those with larger tumors, and those with residual disease at surgery.
Collapse
Affiliation(s)
| | | | | | - A. Jo Chien
- University of California San Francisco, San Francisco, CA
| | | | | | - Anne Wallace
- University of California San Diego, San Diego, CA
| | | | | | - Christina Yau
- University of California San Francisco, San Francisco, CA
| | | | - Andrea Ordonez
- University of California San Francisco, San Francisco, CA
| | - Tulasi Solanki
- University of California San Francisco, San Francisco, CA
| | - Feng Hsiao
- University of California San Francisco, San Francisco, CA
| | - Jen Chieh Lee
- University of California San Francisco, San Francisco, CA
| | - Amrita Basu
- University of California San Francisco, San Francisco, CA
| | | | | | - Amy L. Delson
- University of California San Francisco, San Francisco, CA
| | | | | | | | | | | | - John W. Park
- University of California San Francisco, San Francisco, CA
| | | | | |
Collapse
|
6
|
Devos G, Tosco L, Baldewijns M, Gevaert T, Goffin K, Petit V, Mai C, Laenen A, Raskin Y, Van Haute C, Goeman L, De Meerleer G, Berghen C, Devlies W, Claessens F, Van Poppel H, Everaerts W, Joniau S. ARNEO: A Randomized Phase II Trial of Neoadjuvant Degarelix with or Without Apalutamide Prior to Radical Prostatectomy for High-risk Prostate Cancer. Eur Urol 2022; 83:508-518. [PMID: 36167599 DOI: 10.1016/j.eururo.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/08/2022] [Accepted: 09/06/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND High-risk prostate cancer (PCa) patients have a high risk of biochemical recurrence and metastatic progression following radical prostatectomy (RP). OBJECTIVE To determine the efficacy of neoadjuvant degarelix plus apalutamide before RP compared with degarelix with a matching placebo. DESIGN, SETTING, AND PARTICIPANTS ARNEO was a randomized, placebo-controlled, phase II neoadjuvant trial before RP performed between March 2019 and April 2021. Eligible patients had high-risk PCa and were amenable to RP. INTERVENTION Patients were randomly assigned at a 1:1 ratio to degarelix (240-80-80 mg) + apalutamide (240 mg/d) versus degarelix + matching placebo for 3 mo followed by RP. Prior to and following neoadjuvant treatment, pelvic 18F-PSMA-1007 positron emission tomography (PET)/magnetic resonance imaging (MRI) was performed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was the difference in proportions of patients with minimal residual disease (MRD; = residual cancer burden (RCB) ≤0.25 cm3 at final pathology). Secondary endpoints included differences in prostate-specific antigen responses, pathological staging, and change in TNM stage on prostate-specific membrane antigen (PSMA) PET/MRI following hormonal treatment. Biomarkers (immunohistochemical staining on prostate biopsy [PTEN, ERG, Ki67, P53, GR, and PSMA] and PSMA PET/MRI-derived characteristics) associated with pathological response (MRD and RCB) were explored. RESULTS AND LIMITATIONS Patients were randomized to neoadjuvant degarelix + apalutamide (n = 45) or degarelix + matching placebo (n = 44) for 12 wk and underwent RP. Patients in the degarelix + apalutamide arm achieved a significantly higher rate of MRD than those in the control arm (38% vs 9.1%; relative risk [95% confidence interval] = 4.2 [1.5-11], p = 0.002). Patients with PTEN loss in baseline prostate biopsy attained significantly less MRD (11% vs 43%, p = 0.002) and had a higher RCB at final pathology (1.6 vs 0.40 cm3, p < 0.0001) than patients without PTEN loss. Following neoadjuvant hormonal therapy, PSMA PET-estimated tumor volumes (1.2 vs 2.5 ml, p = 0.01) and maximum standardized uptake value (SUVmax; 4.3 vs 5.7, p = 0.007) were lower in patients with MRD than in patients without MRD. PSMA PET-estimated volume and PSMA PET SUVmax following neoadjuvant treatment correlated significantly with RCB at final pathology (both p < 0.001). CONCLUSIONS In high-risk PCa patients, neoadjuvant degarelix plus apalutamide prior to RP results in a significantly improved pathological response (MRD and RCB) compared with degarelix alone. Our trial results provide a solid hypothesis-generating basis for neoadjuvant phase 3 trials, which are powered to detect differences in long-term oncological outcome following neoadjuvant androgen receptor signaling inhibitor therapy. PATIENT SUMMARY In this study, we looked at the difference in pathological responses in high-risk prostate cancer patients treated with degarelix plus apalutamide or degarelix plus matching placebo prior to radical prostatectomy. We demonstrated that patients treated with degarelix plus apalutamide achieved a significantly better tumor response than patients treated with degarelix plus matching placebo. Long-term follow-up is required to determine whether improved pathological outcome translates into better oncological outcomes.
Collapse
Affiliation(s)
- Gaëtan Devos
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lorenzo Tosco
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Thomas Gevaert
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Karolien Goffin
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Valentin Petit
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Cindy Mai
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Center, KU Leuven, Leuven, Belgium
| | - Yannic Raskin
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Carl Van Haute
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Lieven Goeman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Charlien Berghen
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Wout Devlies
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - Frank Claessens
- Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | | | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| |
Collapse
|
7
|
See SHC, Siziopikou KP. Pathologic evaluation of specimens after neoadjuvant chemotherapy in breast cancer: Current recommendations and challenges. Pathol Res Pract 2021; 230:153753. [PMID: 34990870 DOI: 10.1016/j.prp.2021.153753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/21/2022]
Abstract
Neoadjuvant chemotherapy is increasingly used to optimize breast conservation surgery and is becoming a standard of care in a subset of breast cancer patients. An accurate pathologic assessment is crucial in guiding clinical decisions and subsequent management and prognosis. This review aims to summarize the most current literature, recommendations, and challenges in the pathologic evaluation of breast cancer after neoadjuvant chemotherapy. Included are the most current definitions of the different types of tumor response, the underlying factors that can affect tumor response, how to assess lymph nodes, margins, and tumor markers post-neoadjuvant chemotherapy, as well as the different classification systems a pathologist can use to assess residual disease. In this era of de-escalation of surgical treatment, studies on imaging techniques to assess residual disease and avoid surgery after neoadjuvant chemotherapy have also been done. However, at least for now, surgical treatment remains the preferred practice. As such, pathologists play an increasingly critical role in standardizing assessment of residual disease post-neoadjuvant chemotherapy, and in optimizing the knowledge gained by this approach to breast cancer therapy.
Collapse
|
8
|
Sejben A, Kószó R, Kahán Z, Cserni G, Zombori T. Examination of Tumor Regression Grading Systems in Breast Cancer Patients Who Received Neoadjuvant Therapy. Pathol Oncol Res 2020; 26:2747-2754. [PMID: 32691390 PMCID: PMC7471177 DOI: 10.1007/s12253-020-00867-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/29/2020] [Indexed: 12/16/2022]
Abstract
Neoadjuvant therapy is a common form of treatment in locally advanced breast cancer (LABC) patients. Besides some guidelines for grading regression, a standardized general scheme is not yet available. The aim of our study was to compare the prognostic impact of different regression grading systems, namely the TR/NR, Chevallier, Sataloff, Denkert-Sinn, Miller-Payne, NSABP-B18, Residual Disease in Breast and Nodes and Residual Cancer Burden (RCB) on disease-free (DFS) and overall survival (OS). Data of 746 breast cancer patients treated in neoadjuvant setting between 1999 and 2019 have been included. The different regression grades and follow-up data were collected from medical charts. Statistical analysis included the Kaplan-Meier method, log-rank test and multivariate Cox regression. The average patient age was 55 years. The DFS and OS estimates of patients with complete pathological regression and residual in situ carcinoma have been significantly more favorable than those having partial regression or no signs of regression (pDFS<0.001, pOS < 0.001). Significant differences were found between DFS estimates of classes with partial regression and without regression defined by RCB. Concerning DFS estimates, the RCB classification (p = 0.019), while regarding OS data the y-stage (p = 0.011) and the nodal status (ypN; p = 0.045) were significant prognosticators by multivariate Cox regression. Regression grading systems help the evaluation of regression in LABC patients treated with neoadjuvant therapy. Of the several grading systems compared, the RCB classification makes the best distinction between the outcomes of the different classes, therefore we recommend the inclusion of RCB into the histopathological findings.
Collapse
Affiliation(s)
- Anita Sejben
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás u. 1., Szeged, 6725, Hungary.
| | - Renáta Kószó
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás u. 1., Szeged, 6725, Hungary
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Tamás Zombori
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás u. 1., Szeged, 6725, Hungary
| |
Collapse
|
9
|
Miglietta F, Dieci MV, Tsvetkova V, Griguolo G, Vernaci G, Menichetti A, Faggioni G, Giarratano T, Mioranza E, Genovesi E, Cumerlato E, Bottosso M, Saibene T, Michieletto S, Lo Mele M, Conte P, Guarneri V. Validation of Residual Proliferative Cancer Burden as a Predictor of Long-Term Outcome Following Neoadjuvant Chemotherapy in Patients with Hormone Receptor-Positive/Human Epidermal Growth Receptor 2-Negative Breast Cancer. Oncologist 2020; 25:e1355-e1362. [PMID: 32618068 PMCID: PMC7485331 DOI: 10.1634/theoncologist.2020-0201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/12/2020] [Indexed: 01/22/2023] Open
Abstract
Background The integration of residual cancer burden (RCB) and post‐treatment Ki67 as residual proliferative cancer burden (RPCB) has been proposed as a stronger predictor of long‐term outcome in unselected patients with breast cancer (BC) undergoing neoadjuvant chemotherapy (NACT), as compared with RCB. However, no specific analysis in hormone‐receptor‐positive (HR+) human epidermal growth receptor 2‐negative (HER2−) BC is available so far. Materials and Methods A cohort of 130 patients with HR+/HER2− BC who underwent NACT between 2000 and 2014 was included. Archival surgical specimens were evaluated for RCB. RPCB was calculated by combining RCB and Ki67 as previously described. Patients were categorized in four RCB and RPCB categories (pathological complete response and tertiles). Disease‐free survival (DFS) and overall survival (OS) estimates were determined by Kaplan‐Meier analysis and compared using the log‐rank test. Overall change of χ2 and c‐indexes were used to compare the performance of the prognostic models. Results RPCB was calculated for 85 patients. After a median follow up of 8.5 years, RCB was associated with OS (p = .048) but not with DFS (p = .152); RPCB was instead significantly associated with both DFS and OS (p = .034 and p < .001, respectively). In terms of OS, RPCB provided a significant amount of prognostic information beyond RCB (∆χ2 5.73, p < .001). In addition, c‐index for OS prediction was significantly higher for RPCB as compared with RCB (0.79 vs. 0.61, p = .03). Conclusion This is the first study evaluating RPCB in patients with HR+/HER2− BC treated with NACT. In this independent cohort, RPCB was a strong predictor of DFS and OS. The better performance of RPCB versus RCB was in part due to the ability of RPCB to discriminate a subgroup of patients with a particularly worse prognosis after NACT, who may be candidates for clinical trials evaluating novel adjuvant strategies. Implications for Practice The present work validated residual proliferative cancer burden (RPCB) as a strong predictor of long‐term outcome in patients with hormone receptor‐positive human epidermal growth receptor 2‐negative (HR+/HER2−) breast cancer (BC) treated with neoadjuvant chemotherapy. In addition, results from the present study suggest RPCB as a promising tool to identify patients with HR+/HER2− BC who might potentially benefit from the inclusion in clinical trials evaluating novel or escalated postneoadjuvant treatment strategies because it allowed to discriminate a subgroup of patients with particularly poor prognosis despite having received subsequent endocrine therapy in the adjuvant setting. This article reports on the prognostic value of the Residual Proliferative Cancer Burden index in a cohort of patients with HR‐positive HER2‐negative breast cancer undergoing neoadjuvant chemotherapy.
Collapse
Affiliation(s)
- Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of PadovaPadovaItaly
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of PadovaPadovaItaly
- Division of Oncology 2, Istituto Oncologico Veneto I.R.C.C.SPadovaItaly
| | - Vassilena Tsvetkova
- Department of Surgery, Oncology and Gastroenterology, University of PadovaPadovaItaly
- Anatomy and Histology Unit, Azienda Ospedaliera di PadovaPadovaItaly
| | - Gaia Griguolo
- Department of Surgery, Oncology and Gastroenterology, University of PadovaPadovaItaly
- Division of Oncology 2, Istituto Oncologico Veneto I.R.C.C.SPadovaItaly
| | - Grazia Vernaci
- Department of Surgery, Oncology and Gastroenterology, University of PadovaPadovaItaly
- Division of Oncology 2, Istituto Oncologico Veneto I.R.C.C.SPadovaItaly
| | - Alice Menichetti
- Department of Surgery, Oncology and Gastroenterology, University of PadovaPadovaItaly
- Division of Oncology 2, Istituto Oncologico Veneto I.R.C.C.SPadovaItaly
| | - Giovanni Faggioni
- Division of Oncology 2, Istituto Oncologico Veneto I.R.C.C.SPadovaItaly
| | | | - Eleonora Mioranza
- Division of Oncology 2, Istituto Oncologico Veneto I.R.C.C.SPadovaItaly
| | - Elisa Genovesi
- Department of Surgery, Oncology and Gastroenterology, University of PadovaPadovaItaly
| | - Enrico Cumerlato
- Department of Surgery, Oncology and Gastroenterology, University of PadovaPadovaItaly
| | - Michele Bottosso
- Department of Surgery, Oncology and Gastroenterology, University of PadovaPadovaItaly
| | - Tania Saibene
- Breast Surgery Unit, Istituto Oncologico Veneto I.R.C.C.SPadovaItaly
| | | | - Marcello Lo Mele
- Anatomy and Histology Unit, Azienda Ospedaliera di PadovaPadovaItaly
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of PadovaPadovaItaly
- Division of Oncology 2, Istituto Oncologico Veneto I.R.C.C.SPadovaItaly
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of PadovaPadovaItaly
- Division of Oncology 2, Istituto Oncologico Veneto I.R.C.C.SPadovaItaly
| |
Collapse
|
10
|
Asano Y, Kashiwagi S, Goto W, Takada K, Takahashi K, Hatano T, Noda S, Takashima T, Onoda N, Tomita S, Motomura H, Ohsawa M, Hirakawa K, Ohira M. Prediction of survival after neoadjuvant chemotherapy for breast cancer by evaluation of tumor-infiltrating lymphocytes and residual cancer burden. BMC Cancer 2017; 17:888. [PMID: 29282021 PMCID: PMC5745786 DOI: 10.1186/s12885-017-3927-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/14/2017] [Indexed: 01/11/2023] Open
Abstract
Background The tumor immune environment not only modulates the effects of immunotherapy, but also the effects of other anticancer drugs and treatment outcomes. These immune responses can be evaluated with tumor-infiltrating lymphocytes (TILs), which has frequently been verified clinically. On the other hand, residual cancer burden (RCB) evaluation has been shown to be a useful predictor of survival after neoadjuvant chemotherapy (NAC). In this study, RCB and TILs evaluations were combined to produce an indicator that we have termed “RCB-TILs”, and its clinical application to NAC for breast cancer was verified by subtype-stratified analysis. Methods A total of 177 patients with breast cancer were treated with NAC. The correlation between RCB and TILs evaluated according to the standard method, and prognosis, including the efficacy of NAC, was investigated retrospectively. The RCB and TILs evaluations were combined to create the “RCB-TILs”. Patients who were RCB-positive and had high TILs were considered RCB-TILs-positive, and all other combinations were RCB-TILs-negative. Results On multivariable analysis, being RCB-TILs-positive was an independent factor for recurrence after NAC in all patients (p < 0.001, hazard ratio = 0.048), triple-negative breast cancer (TNBC) patients (p = 0.018, hazard ratio = 0.041), HER2-positive breast cancer (HER2BC) patients (p = 0.036, hazard ratio = 0.134), and hormone receptor-positive breast cancer (HRBC) patients (p = 0.002, hazard ratio = 0.081). Conclusions The results of the present study suggest that RCB-TILs is a significant predictor for breast cancer recurrence after NAC and may be a more sensitive indicator than TILs alone. Electronic supplementary material The online version of this article (doi: 10.1186/s12885-017-3927-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yuka Asano
- Department of Surgical Oncology, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | | | - Wataru Goto
- Department of Surgical Oncology, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Koji Takada
- Department of Surgical Oncology, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | | | - Takaharu Hatano
- Department of Plastic and Reconstructive Surgery, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Satoru Noda
- Department of Surgical Oncology, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tsutomu Takashima
- Department of Surgical Oncology, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Naoyoshi Onoda
- Department of Surgical Oncology, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shuhei Tomita
- Department of Pharmacology, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hisashi Motomura
- Department of Plastic and Reconstructive Surgery, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masahiko Ohsawa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kosei Hirakawa
- Department of Surgical Oncology, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masaichi Ohira
- Department of Surgical Oncology, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| |
Collapse
|
11
|
Martín M, Chacón JI, Antón A, Plazaola A, García-Martínez E, Seguí MA, Sánchez-Rovira P, Palacios J, Calvo L, Esteban C, Espinosa E, Barnadas A, Batista N, Guerrero A, Muñoz M, Romio E, Rodríguez-Martín C, Caballero R, Casas MI, Rojo F, Carrasco E, Antolín S. Neoadjuvant Therapy with Weekly Nanoparticle Albumin-Bound Paclitaxel for Luminal Early Breast Cancer Patients: Results from the NABRAX Study (GEICAM/2011-02), a Multicenter, Non-Randomized, Phase II Trial, with a Companion Biomarker Analysis. Oncologist 2017; 22:1301-1308. [PMID: 28701571 DOI: 10.1634/theoncologist.2017-0052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/09/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nanoparticle albumin-bound paclitaxel (nab-Paclitaxel) is an alternative to standard taxanes for breast cancer (BC) treatment. We evaluated nab-Paclitaxel efficacy as neoadjuvant treatment for early estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2-) disease. MATERIALS AND METHODS Women with ER+, HER2-, stage II-III BC were treated preoperatively with four cycles of weekly nab-Paclitaxel (150 mg/m2), 3 weeks on and 1 week off. We hypothesized that poor pathological response rate (residual cancer burden [RCB] III; Symmans criteria) would be ≤16%. RESULTS Eighty-one patients with a median age of 47 years were treated; 64.2% were premenopausal, and 69% of tumors were stage II. Residual cancer burden III rate was 28.4% (95% confidence interval [CI]: 18.6%-38.2%), RCB 0+I (good response) rate was 24.7% (95% CI: 15.3%-34.1%) and RCB 0 (complete response) rate was 7.4% (95% CI: 1.7%-13.1%). Objective response rate by magnetic resonance imaging was 76.5% and rate of conversion to breast conserving surgery was 40.0%. The most frequent grade 3 and 4 toxicity was neutropenia (12.3% and 3.7% of patients, respectively), without any febrile neutropenia. Sensory neuropathy grade 2 and 3 were seen in 25.9% and 2.5% of patients, respectively. Tumor secreted protein, acidic, cysteine-rich (SPARC) overexpression was significantly associated with RCB 0 (odds ratio: 0.079; 95% CI: 0.009-0.689; p = .0216). CONCLUSION Despite failing to confirm an RCB III rate ≤16% in nab-Paclitaxel-treated patients, the RCB 0+I rate indicates a significant drug antitumor activity with low rates of grade 3-4 toxicity. Our exploratory biomarker analysis suggests a potential predictive role of complete response for SPARC. Confirmatory analyses are warranted, adapting dose and schedule to decrease peripheral neurotoxicity. (Trial registration: European Clinical Trials Database study number: 2011-004476-10; ClinicalTrials.gov: NCT01565499). IMPLICATIONS FOR PRACTICE The pathological response rate (residual cancer burden [RCB]; Symmans criteria) of nanoparticle albumin-bound paclitaxel administered as neoadjuvant treatment for early estrogen receptor-positive, human epidermal growth factor receptor 2-negative disease was evaluated. Whereas poor response (RCB III) was 24.7%, similar to that for docetaxel, good response (RCB 0+I) reached 23.0%, far superior to the 13% for docetaxel, while keeping toxicity low. Exploratory biomarker analysis suggests secreted protein, acidic, cysteine-rich overexpression in tumor cells as a potential predictor of complete response (RCB 0). Findings point to an encouraging single-agent neoadjuvant treatment with low toxicity, which warrants future research and development.
Collapse
Affiliation(s)
- Miguel Martín
- Oncology Department, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Spain, on behalf of GEICAM (Spanish Breast Cancer Group), Spain
| | - José I Chacón
- Oncology Department, Hospital Universitario Virgen de la Salud, Toledo, Spain
| | - Antonio Antón
- Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Elena García-Martínez
- Oncology Department, Hospital General Universitario Morales Messeguer, Murcia, Spain
| | - Miguel A Seguí
- Oncology Department, Corporación Sanitaria Parc Taulí, Barcelona, Spain
| | | | - José Palacios
- Pathology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Spain, on behalf of GEICAM (Spanish Breast Cancer Group), Spain
| | - Lourdes Calvo
- Oncology Department, Complejo Hospitalario Universitario de la Coruña, La Coruña, Spain
| | - Carmen Esteban
- Oncology Department, Hospital Universitario Virgen de la Salud, Toledo, Spain
| | - Enrique Espinosa
- Oncology Department, Hospital Universitario la Paz, Madrid, Spain
| | - Agusti Barnadas
- Medical Oncology Department, Hospital de Santa Creu i Sant Pau, Institut de Recerca IIB Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Spain, on behalf of GEICAM (Spanish Breast Cancer Group), Spain
| | - Norberto Batista
- Oncology Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Angel Guerrero
- Oncology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - Montserrat Muñoz
- Oncology Department, Hospital Clinic i Provincial, Barcelona, Spain
| | - Estefania Romio
- Pathology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Federico Rojo
- Fundación Jiménez Díaz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Spain, on behalf of GEICAM (Spanish Breast Cancer Group), Spain
| | | | - Silvia Antolín
- Oncology Department, Complejo Hospitalario Universitario de la Coruña, La Coruña, Spain
| |
Collapse
|
12
|
Campbell JI, Yau C, Krass P, Moore D, Carey LA, Au A, Chhieng D, Giri D, Livasy C, Mies C, Rabban J, Sarode VR, Singh B, Esserman L, Chen YY. Comparison of residual cancer burden, American Joint Committee on Cancer staging and pathologic complete response in breast cancer after neoadjuvant chemotherapy: results from the I-SPY 1 TRIAL (CALGB 150007/150012; ACRIN 6657). Breast Cancer Res Treat 2017; 165:181-191. [PMID: 28577078 DOI: 10.1007/s10549-017-4303-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Several pathologic staging systems characterize residual tumor in patients undergoing neoadjuvant chemotherapy for breast cancer. Pathologic complete response (pCR) is now accepted by the Food and Drug Administration as an endpoint for granting accelerated drug approval. Two other systems of post-neoadjuvant pathologic tumor staging-residual cancer burden (RCB) and the American Joint Committee on Cancer post-neoadjuvant therapy staging system (yAJCC)-have been developed to characterize residual tumors when patients do not achieve pCR. The optimal system and the ways in which these systems complement each other have not been fully determined. METHODS Using data from the I-SPY 1 TRIAL, we compared pCR, RCB, and yAJCC as predictors of early recurrence-free survival (RFS) to identify ways to improve post-neoadjuvant pathologic evaluation. RESULTS Among 162 patients assessed, pCR identified patients at lowest risk of recurrence, while RCB and yAJCC identified patients at highest risk. Hormone-receptor (HR) and HER2 subtypes further improved risk prediction. Recursive partitioning indicated that triple-negative or HER2+ patients with yAJCC III or RCB 3 have the highest recurrence risk, with an RFS of 27%. Our analysis also highlighted discrepancies between RCB and yAJCC stratification: 31% of patients had discrepant RCB and yAJCC scores. We identified differential treatment of lymph node involvement and tumor cellularity as drivers of these discrepancies. CONCLUSIONS These data indicate that there is benefit to reporting both RCB and yAJCC for patients in order to identify those at highest risk of relapse.
Collapse
Affiliation(s)
| | | | - Polina Krass
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dan Moore
- University of California, San Francisco, CA, USA
| | - Lisa A Carey
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alfred Au
- University of California, San Francisco, CA, USA
| | | | - Dilip Giri
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Chad Livasy
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carolyn Mies
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Venetia R Sarode
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Baljit Singh
- New York University School of Medicine, New York, NY, USA
| | | | - Yunn-Yi Chen
- University of California, San Francisco, CA, USA.
| |
Collapse
|