Early progression of breast cancer during neoadjuvant chemotherapy may predict poorer prognoses

Abstract

Background: In Finland, breast cancers treated with neoadjuvant chemotherapy (NACT) are usually locally advanced and/or have an inflammatory phenotype. We evaluated early NACT responses in breast tumours and lymph nodes and their correlation with survival. Material and methods: We collected a retrospective dataset of 145 patients with very high-risk but non-metastasised breast cancers that were treated with NACT in a Finnish University Hospital between September 2013 and January 2019. The patients underwent magnetic resonance imaging (MRI) scans before beginning NACT and after every second NACT cycle thereafter. Results: The total pathological complete response rate was only 10.7% and breast cancer-specific survival (BCSS) at 24 months was 93.0%. The 2-year breast cancer-specific survival (BCSS) rate was 93.0%, but this varied from 86.5% for the triple-negative subtype to 100.0% for the luminal Alike subtype. Enlargement of the malignant axillary lymph nodes during the first two NACT cycles was associated with poor BCSS rates in HER2-negative patients (p ¼ .00003 in the univariate analysis; hazard ratio ¼ 26.3; 95% confidence interval ¼ 2.66-259.6; p ¼ .005 in the multivariate analysis). Furthermore, progression in the combined diameters of the breast tumours and axillary lymph nodes during the period between a patient's pre-treatment MRI and her MRI after two NACT cycles was also correlated with worse BCSS rates in both univariate and multivariate analyses. Conclusions: An early MRI assessment after two NACT cycles, specifically of the tumour's axillary lymph nodes, has the potential to predict short-term BCSS in patients with locally advanced HER2negative breast cancers.

Prognostic factors and clinical outcomes of breast cancer patients with disease progression during neoadjuvant systemic therapy

“…Although most patients with breast cancer show partial or complete response to NST, there is still a fraction of patients running into PD. The rate of PD in our center was 1.6%, in accordance with the study by Leisha (1.9%) but lower than the previous data (3%–7%) [ 15 , 16 , 18 , 22 ]. Due to emerging treatment options such as targeted therapy and immunotherapy, the survival outcomes of patients receiving neoadjuvant systematic therapy are constantly improving.…”

Prognostic Factors and Clinical Outcomes of Breast Cancer Patients with Disease Progression During Neoadjuvant Systemic Therapy

“…Although most patients with breast cancer show partial or complete response to NST, there is still a fraction of patients running into PD. The rate of PD in our centre was 1.6%, in accordance with the study by Leisha (1.9%) but lower than the previous data (3-7%) [8][9][11] [15] . Due to emerging treatment options such as targeted therapy and immunotherapy, the survival outcomes of patients receiving neoadjuvant systematic therapy are constantly improving.…”