Background and Purpose: Temozolomide is the standard treatment for patients with newly diagnosed glioblastoma multiform that had methylated O 6 -methylguanine-DNA methyltransferase promotor, but it had a limited efficacy in non-methylated MGMT. Thus the aim of this study is to compare bevacizumab plus irinotecan versus standard temozolomide in newly diagnosed non methylated MGMT glioblastome multiforme.
Local inflammatory markers have been defined as prognostic and predictive markers in triple negative markers as proved by many studies. The prognostic and predictive value of systemic inflammatory markers such as neutrophil lymphocyte ratio (NLR) and lymphocyte monocyte ratio (LMR) remain to be elucidated. Aim of study: To evaluate pathological complete response (PCR) to neoadjuvant chemotherapy in locally advanced cancer breast in relation to tumor infiltrating lymphocytes(TILs), neutrophil lymphocyte ratio and lymphocyte monocyte ratio as well as overall survival and disease free survival. Patients and methods: In Tanta university Hospital, oncology department form January 2012 to December 2013, 67 patients with locally advanced TNBC stage IIB, IIIB 0r IIIC using TNM 8t h edition . All patients received neoadjuvant chemotherapy in the form of dose dense AC followed by paclitaxel (adriamycin & cyclophosphamide 60 mgm/m2 & 600 mgm/m2 respectively the cycle is repeated every 2 weeks for 4 cycles followed by paclitaxel 175mgm/m2 every 2 weeks for 4 cycles). All cycles with G-CSF support. Pre treatment TILs, NLR and LMR were evaluated with PCR and as prognostic factor of survival. Results: Low NLR has been detected in 74.6% of cases and has been associated with high TILs and this was statistically significant (p value=0.03). High LMR was observed in 80.6% of cases and correlated significantly with TILs (p value =0.003). Pathological CR was found to be associated with high TILs, low NLR and high LMR. In our study we evaluated the pre neoadjuvant systemic and local inflammatory markers as prognostic marker we found that in multivariate analysis, the lymphocyte monocyte ratio maintained their statistical significance with overall survival. While tumor infiltrating lymphocyte maintained their statistical significance as prognostic factors with overall survival and disease free survival. Conclusion: Systemic inflammatory markers can be used as marker of pathological complete response in locally advanced triple negative breast6 cancer with neoadjuvant chemotherapy.
Purpose: Tumor-infiltrating lymphocytes (TILs) have a strong prognostic and predictive value in triple-negative breast cancer (TNBC) and HER2 enriched subtype but no other breast subtypes but no studies have evaluated tertiary lymphoid structure (TLS).
Materials and Methods:Eighty patients with stage II and III breast cancer in Tanta oncology and pathology department with luminal A, B and her 2 enriched and TNBC diagnosed with core needle biopsy treated with neoadjuvant chemotherapy (4 AC followed by 12-week taxol + herceptin). TIL and TLS were evaluated histopathologically using hematoxylin and eosin-stained slides. The immune cell aggregates which were TLS positive showed the presence of CD20+ B lymphocytes within the follicles, with areas of CD3+, CD4+ T lymphocytes mainly in the periphery [T-cell zone] resembling the highly organized structures of secondary lymphoid organs.Results: TLS were detected in 53.7% of the tumors in whole breast groups, 83.7% in triple negative subgroup. Increased number of tumor infiltrating lymphocytes and tertiary lymphoid structure are associated with longer OS and DFS for TNBC and HER2-positive breast cancer.
Conclusion:For predicting treatment response in patients with TNBC and HER2 enriched subtype, TILs and TLS may be prognostic and predictive marker triplenegative breast cancer (TNBC) and HER2 enriched subtype but no other breast subtypes.
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