Tumor biology predicts pathologic complete response to neoadjuvant chemotherapy in patients presenting with locally advanced breast cancer Journal Article

Authors: Gentile, L. F.; Plitas, G.; Zabor, E. C.; Stempel, M.; Morrow, M.; Barrio, A. V.
Article Title: Tumor biology predicts pathologic complete response to neoadjuvant chemotherapy in patients presenting with locally advanced breast cancer
Abstract: Background: Neoadjuvant chemotherapy (NAC) is used to convert patients with inoperable locally advanced breast cancer (LABC) to operability, but has not traditionally been used to avoid mastectomy or axillary dissection in this subset. Objective: The purpose of this study was to determine the rates of pathologic complete response (pCR) in LABC patients, and identify factors predictive of pCR to determine if responding patients might be suitable for limited surgery. Methods: From 2006 to 2016, 1522 patients received NAC followed by surgery; 321 had advanced disease in the breast (cT4) and/or in the nodes (cN2/N3). pCR rates were assessed by T and N stage, and receptor subtype. Results: Of 321 LABC patients, 223 were cT4, 77 were cN2, and 82 were cN3. Forty-three percent were hormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) negative (HR+/HER2−), 23% were triple negative, and 34% were HER2+. The overall pCR rate was 25% and differed by receptor subtype (HR+/HER2− 7%, triple negative 23%, HER2+ 48%; p < 0.001). Breast pCR occurred in 27% of patients and was similar in T4 versus non-T4 disease (29% vs. 22%; p = 0.26). Nodal pCR was achieved in 38% of cN+ patients and did not differ by nodal stage (cN1 43%, cN2 36%, cN3 32%; p = 0.23). Nodal pCR was significantly more common than breast pCR (p = 0.014) across all tumor subtypes. Receptor subtype was the only predictor of overall pCR (p < 0.001). Conclusion: In patients with LABC, pCR after NAC was seen in 25%, and did not differ by T or N stage. Tumor biology, but not extent of disease, predicted pCR. Studies assessing the feasibility of surgical downstaging with NAC in LABC patients are warranted. © 2017, Society of Surgical Oncology.
Keywords: adult; human tissue; treatment response; aged; cancer surgery; major clinical study; cisplatin; doxorubicin; fluorouracil; cancer combination chemotherapy; methotrexate; cancer staging; antineoplastic agent; lymph node dissection; breast cancer; mastectomy; tumor volume; epidermal growth factor receptor 2; cyclophosphamide; axillary lymph node; fluorescence in situ hybridization; neoadjuvant chemotherapy; trastuzumab; hormone receptor; lapatinib; pertuzumab; lumpectomy; triple negative breast cancer; estrogen receptor positive breast cancer; human epidermal growth factor receptor 2 positive breast cancer; human; female; article; vinorelbine tartrate; progesterone receptor positive breast cancer
Journal Title: Annals of Surgical Oncology
Volume: 24
Issue: 13
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2017-12-01
Start Page: 3896
End Page: 3902
Language: English
DOI: 10.1245/s10434-017-6085-y
PROVIDER: scopus
PMCID: PMC5697706
PUBMED: 28916978
Notes: Article -- Export Date: 1 December 2017 -- Source: Scopus
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MSK Authors
  1. Andrea Veronica Barrio
    38 Barrio
  2. Monica Morrow
    450 Morrow
  3. George Plitas
    53 Plitas
  4. Emily Craig Zabor
    131 Zabor
  5. Michelle Moccio Stempel
    131 Stempel