Purpose. This study was designed to examine the relationship between breast cancer molecular subtypes and pathological response to neoadjuvant chemotherapy (NAC) ± trastuzumab, in locally advanced breast cancer (LABC). Methods. Female patients with LABC (T2–T4, N0–N2, and M0) who received neoadjuvant chemotherapy + trastuzumab if HER2+ subtype, followed by surgery and radiotherapy ± hormonal therapy, were identified. The primary endpoint was pathologic complete response (pCR) in the breast and axilla (ypT0/ypN0), with final analysis on disease-free survival (DFS) and overall survival (OS). Results. Six hundred eighty-one patients with a median age of 44 years, premenopausal: 70%, median tumour size: 7.0 cm (range 4–11 cm), stage II B: 27% and III A/III B: 73%, ER+/HER2−: 40.8%, ER−/HER2−: 23%, ER+/HER2+: 17.7%, and ER−/HER2+: 18.5%. Overall pCR (ypT0/ypN0) was 23%. The pCR rates based on molecular subtypes were ER+/HER2−: 9%; ER+/HER2+: 29%; ER−/HER2−: 31%; and ER−/HER2+: 37%. At median follow-up of 61 months, ER+/HER2+ and ER+/HER2− subtypes had the best 5-year DFS and OS; meanwhile, ER−/HER2+ and ER−/HER2− subtypes had the worst. Conclusion. Women with ER+/HER2− disease are the least likely to achieve pCR, with the highest rates in HER2+ and triple-negative subgroups. Degree of response is associated with OS; despite the comparatively higher likelihood of achieving pCR in ER−/HER2+ and triple-negative, these subgroups experience a survival detriment. We are consistent with the published data that patients who attain the pathological complete response defined as ypT0/ypN0 have improved outcomes.
Context.—The World Health Organization classification of posttransplant lymphoproliferative disorders divides them into 4 main categories. Objective.—To classify cases of posttransplant lymphoproliferative disorders diagnosed in our institution according to the World Health Organization scheme and correlate the classification and clonality with clinical data. Design.—Cases of posttransplant lymphoproliferative disorders were reviewed. They were classified according to the World Health Organization scheme. Clonality was determined by flow cytometry and/or polymerase chain reaction. Patients' charts were reviewed. Results.—Thirty-one cases were identified. Median age was 33 years. There were 19 cases of kidney, 8 cases of liver, and 4 cases of bone marrow transplant. Immunosuppression consisted of cyclosporin A and prednisone (N = 24) or FK506 and prednisone (N = 7). Twenty cases (63%) were World Health Organization type 3, 7 cases (23%) type 2, 3 cases (6.4%) type 1, and 1 case type 4 posttransplant lymphoproliferative disorder. Ten patients received chemotherapy, 20 patients had reduction of immunosuppression, and 1 had no treatment. Follow-up was available on 25 patients. Seven (43.75%) of 16 with type 3 lesions with available follow-up died of their disease. Five of these patients received reduction of immunosuppression alone. Only 2 of 9 patients with type 3 disease who received chemotherapy died of disease. Two patients with type 2 disease died of unrelated causes. One patient is alive with disease; the remaining patients with types 1 and 2 disease are alive with no disease. Conclusions.—The World Health Organization classification of posttransplant lymphoproliferative disorders is valuable in the identification of subtypes. It helps identify early lesions (1 and 2) requiring reduction of immunosuppression and type 3 disease, which requires chemotherapy from the outset.
21119 Background: Hormone receptor negative breast cancer (BC) is associated with poor outcome. BC patients (pts) with HER2/neu over expression (IHC 3+) are associated as well with poor prognosis. Aim: to further divide breast cancer to prognostic subgroups using interaction between these 2 prognostic factors. Methods: Between January 2002 and May 2004, the clincopathological features as well as treatment results of all non metastatic pts with triple negative BC (TNBC) and those with triple positive BC (TPBC) were reviewed. In all patients the three immunohistochemical markers, ER, PR and HER2/neu were available for review. Results: 113 TNBC pts and 55 TPBC were identified. In the TNBC group; median age was 42y, 76 % were premenopause, 21% with + family history (FH) and 6% were pregnant at diagnosis. Clinical stage (CS): I: 4%, II: 60%, III: 36%. Neo-adjuvant chemotherapy (NACT) was given to 29 %. Modified radical mastectomy (MRM) and breast conservative surgery (BCS) were performed in 49% and 51% respectively. Adjuvant CT (ACT) and radiotherapy (RT) were given to 85% and 84% of the pts. In the TPBC group, the median age was 43y, 71% were premenopause, 16% with + FH, and 2% were pregnant. The CS in the TPBC group was I: 4%, II: 65%, III: 31%. The distributions of NACT, MRM, BCS, ACT and RT in TPBC pts were 35%, 64%, 36%, 60% and 84% respectively. All TPBC pts received adjuvant hormonal therapy and non received adjuvant Herceptin. Relapse rate was 34% in TNBC and 20 % in TPBC (p = 0.04). At a median follow up of 40 months, 72% and 80% of the pts in the TNBC and TPBC groups are alive and disease free respectively. The 4y EFS and OS were 64% and 76% in TNBC and 74% and 89% in TPBC group (p = 0.04 and 0.008 respectively). Conclusions: TNBC is an aggressive neoplasm and has a poor outcome. More aggressive adjuvant chemotherapy and possible biological therapy directed against EGFR, based on previous released information of the prevalence of EGFR in this particular phenotype, should be considered in this group of patients. No significant financial relationships to disclose.
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