How Often Does Modern Neoadjuvant Chemotherapy Downstage Patients to Breast-Conserving Surgery?

Petruolo, Oriana; Sevilimedu, Varadan; Montagna, Giacomo; Le, Tiana; Morrow, Monica; Barrio, Andrea V.

doi:10.1245/s10434-020-08593-5

Cited by 64 publications

(47 citation statements)

References 15 publications

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“…Data from our multivariable model suggests the likelihood of pCR is 12 times more likely in cancers <50 mm, albeit limited to HER2þ disease alone, vs. mixed molecular subtyping in Goorts' analysis. However, patients with HER2þ disease in this study seem dependent upon ER-to achieve breast/ axillary downstaging, irrespective of tumour burden, which reciprocates to data published from the Memorial Sloan Kettering Cancer Centre, New York [41]. Given the invaluable role of ER and HER2/neu in dictating the substratification of breast cancer molecular subtypes and providing targeted therapeutic options through endocrine and anti-HER2 agents, this study further highlights the critical importance of these biomarkers in contemporary breast cancer management during the molecular era.…”

Section: Discussionsupporting

confidence: 88%

“…In the current analysis, it is unsurprising that histopathological and immunohistochemical characteristics such as PgR status, tumour grade and disease burden independently predict breast and axillary pCR, as described in several recent studies [ 15 , [41] , [42] , [43] ]. In their analysis of 2366 breast cancer patients in the Netherlands Cancer Registry treated with NAT, Goorts et al.…”

Section: Discussionmentioning

confidence: 84%

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Clinicopathological response to neoadjuvant therapies and pathological complete response as a biomarker of survival in human epidermal growth factor receptor-2 enriched breast cancer – A retrospective cohort study

et al. 2021

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Background: Human epidermal growth factor receptor-2 (HER2) is overexpressed in 20e25% of breast cancers. Complete eradication of disease following neoadjuvant therapies and chemotherapy has been referred to as pathological complete response (pCR). Aims: To determine clinicopathological predictors of pCR to neoadjuvant therapies and to evaluate pCR as a surrogate to enhanced survival. Methods: Consecutive female patients with HER2 positive (HERþ) breast cancer managed surgically in a single institution between 2005 and 2015 were included. Descriptive statistics and binary logistic regression were used to determine predictors of pCR. Appraisal of pCR as a predictor of survival was performed using Kaplan-Meier curves and Cox regression analysis. Results: 451 patients were included with a mean age of 56.6 ± 13.4 years (range 23e95). Disease-free (DFS) and overall survival (OS) was 82.3% (371/451) and 82.6% (376/451) respectively with a median follow-up of 108.0 months (range 3e184.0). 118 were treated in the neoadjuvant setting (26.2%): tumour size <50 mm (Odds Ratio (OR): 12.156, P ¼ 0.023) and progesterone receptor negativity (OR: 2.762, P ¼ 0.008) independently predicted breast pCR, while ductal carcinoma (OR: 3.203, P ¼ 0.030) and grade 3 disease (OR: 2.788, P ¼ 0.018) predicted axillary pCR. Both breast and axillary pCR predicted enhanced DFS (Hazard Ratio (HR): 0.470 & HR: 0.449) and OS (HR: 0.383 & HR: 0.307). Axillary pCR independently predicted improved OS (HR: 0.326). Conclusion: pCR is sensitive biomarker and surrogate to survival outcomes in HER2þ breast cancer. Patients likely to achieve pCR may be predicted from traditional clinicopathological characteristics and molecular parameters.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 84%

Clinicopathological response to neoadjuvant therapies and pathological complete response as a biomarker of survival in human epidermal growth factor receptor-2 enriched breast cancer – A retrospective cohort study

et al. 2021

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“…This clearly explain the need for breast surgeons to participate in the design of neoadjuvant clinical trials that includes BCS as an end‐point 31 . Institutional studies have shown a conversion rate of 75% from BCS‐ineligible to BCS‐eligible when assessment of BCS is done before starting NAT 32 …”

Section: Discussionmentioning

confidence: 99%

“…31 Institutional studies have shown a conversion rate of 75% from BCS-ineligible to BCS-eligible when assessment of BCS is done before starting NAT. 32 T A B L E 3 (Continued) . This is consistent with other studies in the era of modern neoadjuvant antiHer2 therapies.…”

Section: Breast Surgerymentioning

confidence: 99%

Leveraging the increased rates of pathologic complete response after neoadjuvant treatment in breast cancer to de‐escalate surgical treatments

Esgueva

Siso

Espinosa-Bravo

et al. 2020

Journal of Surgical Oncology

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Introduction: Breast conservative surgery (BCS) and sentinel lymph node biopsy (SLNB) after neoadjuvant treatment (NAT) is safe and effective for selected patients. This aim of this study is to evaluate the impact of anatomic site of response on outcomes and to assess the real population who may benefit from nonsurgical approaches after NAT. Material and Methods: From a prospectively maintained database, patients with T1-4 N0-2 breast cancer undergoing NAT were identified. Clinicopathological and survival rates were compared in relation to response and anatomic site of response. Results: Six hundred and forty-six patients were included in the study. Pathologic complete response (pCR) was an independent factor for BCS and SLN. HER2 positive and TN tumors with cN0 achieving a breast pCR remain ypN0 (p = .002). Residual axillary disease was associated with breast residual tumor (p = .05) and subtype (p = .001). With a median follow up of 35.25 months, patients with any pCR had improved survival when compared with partial response, but not significant differences between pCR, axillary pCR, or breast pCR. Conclusion: Achieving a pCR increases BCS and SLN. In selected subgroups, sparing any axillary surgery after NAT maybe feasible. In cN+ patients, any pCR was associated with survival, but not the anatomic site of response.

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“…Neoadjuvant chemotherapy (NAC) increases the likelihood of breast conservation [1][2][3] and decreases the chances of finding nodal metastases [4][5][6]. Indications for NAC have evolved over time, and downstaging of the axilla in patients who present with nodal metastases has become a common indication for NAC [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Nodal Pathological Complete Response in Asian Women with Stage II–III Node-Positive Breast Cancer

et al. 2021

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Background: Neoadjuvant chemotherapy (NAC) is increasingly used to treat node-positive (N+) breast cancer. Predictors of nodal pathological complete response (pCR) in Asian women are poorly described and there is variety in the management of the axilla after NAC. We evaluated predictors of nodal pCR and axillary management in a cohort of Asian N+ patients. Methods: Consecutive biopsy-proven N+ breast cancer patients treated with NAC were identified from the Shanghai Ruijin Hospital in China. Axillary lymph node dissection was performed on all patients, irrespective of the nodal response to NAC. Results: A total of 323 patients were included. Nodal pCR was achieved in 105 patients (33%), 15% of HR+/HER2– tumors, 38% of HR+/HER2+ tumors, 49% of HR–/HER2+ tumors, and 42% of HR–/HER2–tumors (p < 0.001). Factors associated with nodal pCR were (1) receptor status (HR+/HER2– [referent]: OR 3.42, 95% CI 1.43–8.16, p = 0.006 for HR+/HER2+; OR 4.19, 95% CI 1.85–9.50, p = 0.001 for HR–/HER2+; and OR 2.94, 95% CI 1.11–7.74, p = 0.029 for HR–/HER2–), (2) breast pCR (no pCR [referent]: OR 15.22, 95% CI 6.29–36.79, p < 0.001), and (3) absence of lymphovascular invasion (LVI [referent]: OR 9.04, 95% CI 2.09–39.18, p = 0.003). Conclusion: This study confirmed expected predictors of nodal pCR in Asian women and the benefit of NAC in downstaging the axilla independently of ethnicity.

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How Often Does Modern Neoadjuvant Chemotherapy Downstage Patients to Breast-Conserving Surgery?

Cited by 64 publications

References 15 publications

Clinicopathological response to neoadjuvant therapies and pathological complete response as a biomarker of survival in human epidermal growth factor receptor-2 enriched breast cancer – A retrospective cohort study

Clinicopathological response to neoadjuvant therapies and pathological complete response as a biomarker of survival in human epidermal growth factor receptor-2 enriched breast cancer – A retrospective cohort study

Leveraging the increased rates of pathologic complete response after neoadjuvant treatment in breast cancer to de‐escalate surgical treatments

Predictors of Nodal Pathological Complete Response in Asian Women with Stage II–III Node-Positive Breast Cancer

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