Hormone receptor-negative as a predictive factor for pathologic complete response to neoadjuvant therapy in breast cancer

Silva, Luana Carolina Ferreira Fiuza; Arruda, Lilian Silva Martins de; Filho, Waldec Jorge David; Cruz, Felipe José Silva Melo; Trufelli, Damila Cristina; Giglio, Auro del

doi:10.31744/einstein_journal/2019ao3434

Cited by 8 publications

(8 citation statements)

References 27 publications

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“…The sensitivity analysis considered variations in the effectiveness of different sub-groups, changing the clinical staging and positive/negative ER and PR in each tested scenario. Patients with negative HR had better overall clinical results compared with patients with positive HR, which is in line with available literature [30]. The clinical staging II with negative HR resulted in an higher ICER versus clinical staging II with positive HR.…”

Section: Discussionsupporting

confidence: 88%

The addition of neoadjuvant pertuzumab for the treatment of HER2+ breast cancer: a cost estimate with real-world data

et al. 2021

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Background Breast cancer (BC) is largely prevalent worldwide. HER2-positive BC account for roughly 20–25% of all BC cases and has an overall survival lower than other BC. Innovation on BC therapeutics is a constant, but novel therapies have higher costs. Therefore, cost-effectiveness research is essential to provide healthcare decision-makers with solid foundations for a resource allocation. This study aims to estimate the average direct medical costs/patient and cost-effectiveness of adding pertuzumab in neoadjuvant treatment (NeoT) for HER2-positive breast cancer (BC). Methods Two retrospective real-world consecutive cohorts of ≥18yo female patients diagnosed with HER2-positive BC treated with NeoT at the Breast Clinic of IPO-Porto were studied. The AC-DH regimen (2012–2015) comprised 8 cycles of neoadjuvant therapy (4 cycles of doxorubicin + cyclosphosphamide followed by 4 cycles ofdocetaxel + trastuzumab), while the AC-DHP regimen (2015–2017) included also pertuzumab as NeoT. NeoT was followed by surgery and adjuvant trastuzumab. Micro-costing technique and a bottom-up approach was used comprising all medical direct costs from the hospital perspective. Unit costs were obtained from government official prices or from IPO-Porto costing system. Costs were adjusted to 2017 and are expressed in euros. Multivariable logistic regression models were used for effectiveness assessment, while generalized linear models with gamma distribution were used for costs. ICER was calculated using the pathological complete response (pCR) as the preferential measure of effectiveness. Sensitivity analysis was also performed. Results AC-DHP (n = 40) and AC-DH (n = 54) cohorts had heterogenous patient profiles (median age 43y/53y; 67.5%/59.3% positive HR; 60.0%/27.8% operable; 25.0%/24.1% inflammatory, respectively). The AC-DHP average total cost/patient was 56,375€, with pertuzumab accounting for 13,978€ (24.79%) and increasing in 15,982€ the average cost/patient (p < 0.001). Clinical staging and hormone receptors (HR) were significantly associated with pCR. ICER was 1.370€ per percentage point of pCR. Conclusions ICER was more favourable in stage III HR negative BC patients compared to other patient profiles. Innovative treatments access is critical to deliver high-quality healthcare, but sustainability must be considered. These results suggest the importance of establishing a cost-effectiveness profile of Pertuzumab in NeoT for HER2-positive BC.

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Section: Discussionsupporting

confidence: 88%

The addition of neoadjuvant pertuzumab for the treatment of HER2+ breast cancer: a cost estimate with real-world data

et al. 2021

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“…The frequency of pCR was also higher in patients with HR-negative cancer, which is in line with previous studies. [ 28 – 30 ] The dual-blockade group had a greater proportion of conservative surgery and a lower rate of axillary clearance, as expected.…”

Section: Discussionsupporting

confidence: 66%

Pertuzumab in Combination with Trastuzumab and Docetaxel in the Neoadjuvant Treatment for HER2-Positive Breast Cancer

Vieira

Borges

Pereira

et al. 2022

Journal of Immunotherapy and Precision Oncology

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Introduction This study aims to assess safety and effectiveness of pertuzumab in combination with trastuzumab and docetaxel in the neoadjuvant treatment (NeoT) of HER2-positive breast cancer. Methods Two consecutive retrospective cohorts (n = 94, 2012–2015 and 2015–2017) of adult women with HER2-positive breast cancer, receiving NeoT at the breast clinic in Portugal (IPO-Porto), were followed. All patients had surgery and received trastuzumab as adjuvant therapy. The 2012–2015 cohort received doxorubicin, cyclophosphamide, docetaxel plus trastuzumab, whereas the 2015–2017 cohort was treated with the same protocol plus pertuzumab. Results The 2012–2015 cohort was older (median 53 years), with locally advanced tumors (48.1%), mostly hormone receptor positive (59.3%). The 2015–2017 cohort was younger (median 43 years) with 60% operable tumors. Pathologic complete response (pCR) improved in the second cohort, while maintaining a good safety profile and tolerability. Clinical staging (p = 0.001) and hormone receptor (p = 0.003) were significant predictors of pCR, but not treatment regimen (p = 0.304). Conclusion Further research with larger samples and longer follow-up is needed to understand the clinical differences. Clinical effectiveness of treatment should also be measured through overall and progression-free survival.

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“…In the study by Silva et al of 243 patients, the presence of negative hormone receptors was found to be a predictive factor of pCR and associated with shorter OS and DFS. pCR was found to be associated with longer DFS and OS 17 . In several studies where pCR was achieved after NAC, it has been shown that the risk of death decreases and OS increases 9,15,17,18 .…”

Section: Discussionmentioning

confidence: 91%

Factors affecting pathological complete response after neoadjuvant chemotherapy in breast cancer: a single-center experience

Mermut

İnanç

Gürsu

et al. 2021

Rev. Assoc. Med. Bras.

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OBJECTIVE:The aim of this study was to examine the characteristics of patients admitted to our hospital with a diagnosis of breast cancer who reached pathological complete response after being operated following eight cycles of neoadjuvant chemotherapy. METHODS:Between 2015-2020, patients with pathological complete response who were operated on after neoadjuvant chemotherapy and sent to our clinic for radiotherapy were evaluated. RESULTS:The median age of the patients was 51 years. The most common histological type was invasive ductal cancer. The number of pathological complete response patients was 74 (28%), and the number of non-pathological complete response patients was 188 (72%).Patients with pathological complete response had a smaller tumor diameter than the non-pathological complete response group (p=0.001).For pathological complete response, T1 stage, N1 stage, NG 3, Ki-67 >20%, negative estrogen receptor, negative progesterone receptor, positive Cerb-B2, and adding trastuzumab to chemotherapy were statistically significant (p<0.05). Before neoadjuvant chemotherapy, stage T1-T2 (p=0.036), LN0-1 (p=0.026), Cerb-B2 positivity (p=0.025), and an initial nuclear grade of three (p=0.001) were found to be the factors affecting pathological complete response.CONCLUSIONS: With neoadjuvant chemotherapy, the size of locally advanced tumors decreases, allowing breast conserving surgery.The neoadjuvant chemotherapy response can be used as an early indicator of the prognosis of patients with breast cancer. Today, neoadjuvant chemotherapy is also used for patients with early-stage, operable breast cancer because it has been shown in many studies that reaching pathological complete response is associated with positive long-term results. If we can identify patients who have reached pathological complete response before neoadjuvant chemotherapy, we think we can also determine a patient-specific treatment plan at the beginning of treatment.

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Hormone receptor-negative as a predictive factor for pathologic complete response to neoadjuvant therapy in breast cancer

Cited by 8 publications

References 27 publications

The addition of neoadjuvant pertuzumab for the treatment of HER2+ breast cancer: a cost estimate with real-world data

The addition of neoadjuvant pertuzumab for the treatment of HER2+ breast cancer: a cost estimate with real-world data

Pertuzumab in Combination with Trastuzumab and Docetaxel in the Neoadjuvant Treatment for HER2-Positive Breast Cancer

Factors affecting pathological complete response after neoadjuvant chemotherapy in breast cancer: a single-center experience

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