Adjuvant extension of chemotherapy after neoadjuvant therapy may not improve outcome in early-stage breast cancer

Knauer, Michael; Haid, A.; Schneider, Yecheskel; Köberle-Wührer, Roswitha; Lang, Alois; Winder, Thomas; Alton, R.; Jasarevic, Zerina; Säly, Christoph; Offner, Felix; Wenzl, E.; DeVries, Alexander

doi:10.1016/j.ejso.2008.10.001

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…This effect was seen in the entire study population and in the high-risk subgroups, such as triple-negative tumors. This finding is supported by a previous report that suggested that postneoadjuvant chemotherapy could exert adverse effects on survival: patients in that study seemed to experience a significant decrease of actuarial 5-year disease-free survival, distant disease-free survival, and locoregional recurrence-free survival, 14 independently of other tumor-related factors when they received postneoadjuvant chemotherapy. In line with those data, postneoadjuvant chemotherapy was the only factor significantly associated with shorter OS in the multivariate model of our study.…”

Section: Regina Promberger Et Alsupporting

confidence: 87%

Postoperative CMF Does Not Ameliorate Poor Outcomes in Women With Residual Invasive Breast Cancer After Neoadjuvant Epirubicin/Docetaxel Chemotherapy

Promberger

Dubsky

Mittlböck

et al. 2015

Clinical Breast Cancer

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Section: Regina Promberger Et Alsupporting

confidence: 87%

Postoperative CMF Does Not Ameliorate Poor Outcomes in Women With Residual Invasive Breast Cancer After Neoadjuvant Epirubicin/Docetaxel Chemotherapy

Promberger

Dubsky

Mittlböck

et al. 2015

Clinical Breast Cancer

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“…In women with operable non-metastatic breast cancer, the long-term clinical outcome in terms of survival and rate of recurrence is the same with neoadjuvant chemotherapy as with adjuvant chemotherapy [1], or the addition of adjuvant to neoadjuvant chemotherapy [2]. The addition of a taxane to anthracycline-based preoperative chemotherapy significantly improved the clinical response rate and pathologic complete response (pCR) rate but did not result in increased survival [3,4].…”

Section: Introductionmentioning

confidence: 98%

TP53 genomics predict higher clinical and pathologic tumor response in operable early-stage breast cancer treated with docetaxel-capecitabine ± trastuzumab

Glück

Ross

Royce

et al. 2011

Breast Cancer Res Treat

206

172

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To determine rates of pathologic complete response (pCR) and near-complete response (npCR) in operable early-stage breast cancer using neoadjuvant capecitabine plus docetaxel, with or without trastuzumab, and investigate biomarkers of pathologic response. Women with operable early-stage breast cancer were enrolled in a multicenter study of neoadjuvant therapy for four 21-day cycles with capecitabine 825 mg/m(2) plus docetaxel 75 mg/m(2) if human epidermal growth factor receptor 2 (HER2)-negative, and additionally, a standard trastuzumab dose if HER2-positive. Primary endpoint was rate of pCR and npCR. Secondary endpoints were potential associations between response and TP53 mutational analysis using the AmpliChip TP53 assay or immunohistochemical (IHC) staining, and genomic subtyping using the PAM50 assay. In patients who completed treatment and surgery, pCR and npCR rates were 15.8% in patients with HER2-negative and 50% in patients with HER2-positive tumors. Stratified by genomic subtype, patients of HER2-enriched subtype had the best response (72.2%), and luminal A (9.1%) and B (4.8%) subtypes, the poorest. Of 147 patients tested for TP53 mutations using the AmpliChip assay, 78 variants were detected; 55 were missense. Response rate among TP53-mutated patients was 30%, significantly higher than TP53 wild-type patients (10%; P = 0.0032). Concordance between AmpliChip mutation status versus TP53 IHC staining was 65%, with AmpliChip status predictive of response and IHC status not predictive. Capecitabine plus docetaxel in HER2-negative, and with trastuzumab in HER2-positive patients, provided a good response rate with four cycles of non-anthracycline-containing therapy. TP53 mutational analysis and genomic subtyping were predictive.

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“…According to the results of the in vivo chemosensitivity test, these patients could have better clinical outcome by changing the resistant chemotherapeutic regimen to a non-cross-resistant chemotherapeutic regimen. However, in the MDACC trial, the change to a non-cross-resistant regimen in an adjuvant setting did not improve the outcome for the patients with a poor response to NC [16]. The NSABP B-27 trial did not identify any group of patients who would benefit from adding neoadjuvant or adjuvant docetaxel chemotherapy in patients who received four cycles of neoadjuvant doxorubicin and cyclophosphamide [4,13].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors in Patients with Stage II/III Breast Cancer Treated with Adjuvant Extension of Neoadjuvant Chemotherapy: A Retrospective Cohort Study with Ten-Years of Follow-Up Data

et al. 2011

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PurposeThe aim of this retrospective study was to identify the reliable long term prognostic factors in patients with stage II/III breast cancer who were treated with an adjuvant extension of neoadjuvant chemotherapy (NC).MethodsWomen under the age of 70-years, with previously untreated clinical stage II and III breast cancer, were treated with NC, which was comprised of three cycles of FEC (5-FU, epirubicin, and cyclophosphamide every 3 weeks) or MMM (methotrexate, mitoxantrone, and mitomycin-C every 3 weeks) with an adjuvant extension of three cycles of the same regimen.ResultsCumulative 10-years disease-free survival (DFS) was 87.3% for patients with a good response and 55.5% for patients with no response (p=0.032); 92.9% for node negative patients, 75.0% for 1-3 positive nodes, 50.0% for 4-9 positive nodes and no survival for 10 or more positive nodes (p<0.001). Cumulative 10-years overall survival (OS) was 89.1% for patients with good response and 55.5% for patients with no response (p=0.024); 95.2% for node negative patients, 80.0% for 1-3 positive nodes, 50.0% for 4-9 positive nodes and no survival for 10 or more positive nodes (p<0.001). No significant difference was observed in DFS and OS between the FEC and MMM treated groups.ConclusionBased on a review of data with a long follow-up, only the clinical response to NC and the absolute number of metastatic axillary lymph node identified at surgical staging were independent predictors of both DFS and OS in patients with stage II/III breast cancer patients treated with adjuvant extension of NC.

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Adjuvant extension of chemotherapy after neoadjuvant therapy may not improve outcome in early-stage breast cancer

Cited by 4 publications

References 17 publications

Postoperative CMF Does Not Ameliorate Poor Outcomes in Women With Residual Invasive Breast Cancer After Neoadjuvant Epirubicin/Docetaxel Chemotherapy

Postoperative CMF Does Not Ameliorate Poor Outcomes in Women With Residual Invasive Breast Cancer After Neoadjuvant Epirubicin/Docetaxel Chemotherapy

TP53 genomics predict higher clinical and pathologic tumor response in operable early-stage breast cancer treated with docetaxel-capecitabine ± trastuzumab

Prognostic Factors in Patients with Stage II/III Breast Cancer Treated with Adjuvant Extension of Neoadjuvant Chemotherapy: A Retrospective Cohort Study with Ten-Years of Follow-Up Data

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