Clinical and pathological response to primary chemotherapy in operable breast cancer

Chollet, Philippe; Charrier, Sabine; Brain, Étienne; Curé, Hervé; Praagh, Isabelle Van; Feillel, V.; Latour, M. De; Dauplat, J.; Misset, Jean-Louis; Ferriere, J. P.

doi:10.1016/s0959-8049(97)00038-5

Cited by 105 publications

(55 citation statements)

References 16 publications

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“…Class III consists of invasive carcinomas with changes related to therapy and class IV have few or no changes following treatment. Chevallier and co-workers subsequently reported on 50 patients treated with an anthracycline-based neoadjuvant regimen (Chollet et al, 1997). In total, 11 (22%) cases were reported in class I and a further four (8%) in class II.…”

Section: Discussionmentioning

confidence: 99%

Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

et al. 2006

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Patients who have no residual invasive cancer following neoadjuvant chemotherapy for breast carcinoma have a better overall survival than those with residual disease. Many classification systems assessing pathological response to neoadjuvant chemotherapy include residual ductal carcinoma in situ (DCIS) only in the definition of pathological complete response. The purpose of this study was to investigate whether patients with residual DCIS only have the same prognosis as those with no residual invasive or in situ disease. A retrospective analysis of a prospectively maintained database identified 435 patients, who received neoadjuvant chemotherapy for operable breast cancer between February 1985 and February 2003. Of these, 30 (7%; 95% CI 5 -9%) had no residual invasive disease or DCIS and 20 (5%; CI 3 -7%) had residual DCIS only. With a median follow-up of 61 months, there was no statistical difference in disease-free survival, 80% (95% CI 60 -90%) in those with no residual invasive or in situ disease and 61% (95% CI 35 -80%) in those with DCIS only (P ¼ 0.4). No significant difference in 5-year overall survival was observed, 93% (95% CI 75 -98%) in those with no residual invasive or in situ disease and 82% (95% CI 52 -94%) in those with DCIS only (P ¼ 0.3). Due to the small number of patients and limited number of events in each group, it is not possible to draw definitive conclusions from this study. Further analyses of other databases are required to confirm our finding of no difference in disease-free and overall survival between patients with residual DCIS and those with no invasive or in situ disease following neoadjuvant chemotherapy for breast cancer.

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Section: Discussionmentioning

confidence: 99%

Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

et al. 2006

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“…Between 1982 and 2001, 451 patients were treated by six cycles at 21-to 28-day intervals of neoadjuvant chemotherapy into five prospective phase II trials (Table 1), previously published (Belembaogo et al, 1992;Chollet et al, 1997Chollet et al, , 2000Van Praagh et al, 2001. The tumour size was 30 mm in diameter or more, or was situated in the central area of the nipple; all patients presented with stage II-III operable breast cancer, according to the International Union Against Cancer (UICC) recommendations (Sobin and Wittekind, 1997).…”

Section: Patients and Treatment Modalitiesmentioning

confidence: 99%

Is Nottingham prognostic index useful after induction chemotherapy in operable breast cancer?

et al. 2003

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The Nottingham prognostic index (NPI), based on tumour size in breast, node involvement and Scarff -Bloom -Richardson (SBR) grading, has been shown to constitute a definitive prognostic factor of primary operable breast cancer in the adjuvant setting. We performed a retrospective study to evaluate the prognostic value of this index in 163 patients after neoadjuvant chemotherapy. Secondly, we examined the influence on survival of a revised NPI, only based on residual tumour size in breast and SBR grading in 228 patients, and consequently called breast grading index (BGI). The prognostic value of these two indices was also evaluated by replacing the SBR grade with the MSBR grade, a French modified SBR grading; the modified NPI (MNPI) and modified BGI (MBGI) were, respectively, obtained in 153 and 222 patients. At a median follow-up of 9.3 years, survival was significantly related to these four indices (Po0.001). Multivariate analysis revealed that MBGI was the only one which retained a prognostic influence on disease-free survival (Po0.02). In conclusion, the 'amount' of residual tumour in breast and/or nodes, as defined by NPI and revised indices, confers a determinant prognosis after neoadjuvant chemotherapy, inviting an alternative postsurgical treatment for a subgroup of patients with a decreased survival.

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“…Table 1 gives the precise protocols for the five regimens, which were administered for six cycles. The primary end points for the induction chemotherapy regimens consisted of determination of clinical and particularly pathological response rates, as reported previously (Belembaogo et al, 1992;Van Praagh et al, 1995Chollet et al, 1997Chollet et al, , 2000.…”

Section: Patient Selectionmentioning

confidence: 99%

“…However, Taxotere 1 alone has been tested, as it had a better clinical activity than doxorubicin at the optimal dose in first line for metastatic patients (Khayat et al, 2001). The pCR rates obtained have raised from 5.6 to 33.3%; all these individual studies have been published (Belembaogo et al, 1992;Van Praagh et al, 1995Chollet et al, 1997Chollet et al, , 2000. The database of individual survival has been actualised and pooled to explore the prognosis value of pCR on a large number of patients.…”

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confidence: 99%

Prognostic significance of a complete pathological response after induction chemotherapy in operable breast cancer

et al. 2002

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Only a few papers have been published concerning the incidence and outcome of patients with a pathological complete response after cytotoxic treatment in breast cancer. The purpose of this retrospective study was to assess the outcome of patients found to have a pathological complete response in both the breast and axillary lymph nodes after neoadjuvant chemotherapy for operable breast cancer. Our goal was also to determine whether the residual pathological size of the tumour in breast could be correlated with pathological node status. Between 1982 and 2000, 451 consecutive patients were registered into five prospective phase II trials. After six cycles, 396 patients underwent surgery with axillary dissection for 277 patients (69.9%). Pathological response was evaluated according to the Chevallier's classification. At a median follow-up of 8 years, survival was analysed as a function of pathological response. A pathological complete response rate was obtained in 60 patients (15.2%) after induction chemotherapy. Breast tumour persistence was significantly related to positive axillary nodes (P=5.10 76 ). At 15 years, overall survival and disease-free survival rates were significantly higher in the group who had a pathological complete response than in the group who had less than a pathological complete response (P=0.047 and P=0.024, respectively). In the absence of pathological complete response and furthermore when there is a notable remaining pathological disease, axillary dissection is still important to determine a major prognostic factor and subsequently, a second non cross resistant adjuvant regimen or high dose chemotherapy could lead to a survival benefit.

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Clinical and pathological response to primary chemotherapy in operable breast cancer

Cited by 105 publications

References 16 publications

Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma

Is Nottingham prognostic index useful after induction chemotherapy in operable breast cancer?

Prognostic significance of a complete pathological response after induction chemotherapy in operable breast cancer

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