Impact of treatment characteristics on response of different breast cancer phenotypes: pooled analysis of the German neo-adjuvant chemotherapy trials

Minckwitz, Gϋnter von; Untch, Michael; Nüesch, Eveline; Loibl, Sibylle; Kaufmann, M.; Kümmel, Sherko; Fasching, Peter A.; Eiermann, W.; Blohmer, Jens-Uwe; Costa, Serban Dan; Mehta, Keyur; Hilfrich, J.; Jackisch, Christian; Gerber, Bernd; Bois, Andreas du; Huober, Jens; Hanusch, Claus; Konecny, Gottfried E.; Fett, W; Stickeler, Elmar; Harbeck, Nadia; Müller, Volkmar; Jüni, Peter

doi:10.1007/s10549-010-1228-x

Cited by 240 publications

(155 citation statements)

References 24 publications

Supporting

Mentioning

129

Contrasting

Unclassified

Order By: Relevance

“…Other factors that were associated with a high pCR-rate include an adequate cumulative dose of anthracyclineand taxane-based neoadjuvant chemotherapy and the concurrent use of trastuzumab in patients with HER2-positive tumours. The use of capecitabine was only associated with an improved pCR-rate when the addition of capecitabine did not lead to a reduction of the delivered anthracycline dose [11].…”

Section: Predictive Role Of Pcrmentioning

confidence: 97%

“…An important advantage of pre-operative chemotherapy is that more patients with larger tumours can be treated with breast conserving surgery. Most neoadjuvant chemotherapy or endocrine trials, such as NSABP-B18 and B 27 [9], EORTC 10902 [1], Fem-024 [10] and the AGO B and GBG-trials [11], report an increase in the percentage of patients that could be treated with breast conservation. Approx.…”

Section: Role Of Surgery In Neoadjuvant Therapymentioning

confidence: 99%

“…For example, some investigators have defined pCR as the absence of both in situ and invasive cancer following neoadjuvant chemotherapy, whereas others have considered only the invasive component in the definition. Some investigators have defined pCR as absence of residual cancer in the breast and regional lymph nodes at the time of definitive surgery, whereas others have defined pCR as a complete response in the breast, irrespective of axillary nodal involvement [8,9,11,27,28]. Adoption of a single term with a standard definition would facilitate comparison of clinical trial data.…”

Section: Definition Of Pcrmentioning

confidence: 99%

“…A recent meta-analysis including more than 6000 primary breast cancer patients after neoadjuvant systemic therapy demonstrated that pCR was significantly correlated with improved survival [11]. Patients achieving a pCR after neoadjuvant chemotherapy show a significantly improved DFS and OS compared to those without pCR.…”

Section: Predictive Role Of Pcrmentioning

confidence: 99%

See 3 more Smart Citations

Current and future role of neoadjuvant therapy for breast cancer

et al. 2014

Self Cite

View full text Add to dashboard Cite

a b s t r a c tNeoadjuvant systemic chemotherapy is a possible therapeutic approach for the treatment of locally advanced operable, primarily non-operable or inflammatory breast cancer. Neoadjuvant systemic chemotherapy is an option for breast cancer patients who would require adjuvant chemotherapy otherwise based on clinical and histological examination and imaging. The use of neoadjuvant systemic therapy in operable breast cancer is currently increasing because of its advantages that include higher rates of breast conserving surgery and the possibility of measuring early in-vivo response to systemic treatment. The timing of axillary sentinel lymph node diagnosis (i.e. before or after neoadjuvant chemotherapy) is critical in that it may influence the likelihood of axillary preservation. It is not yet clear if neoadjuvant therapy might improve outcomes in certain subgroups of breast cancer patients. Neoadjuvant treatment modalities require a close collaboration between oncology professionals, including surgeons, gynecologists, medical oncologists, radiation oncologists, radiologists and pathologists. The most important parameter for treatment success and improved overall survival is the achievement of a pathologic complete response (pCR), although the role of pCR in patients with luminal A like tumours might be less informative. Identification of patient subgroups with high pCR rates may allow less invasive surgical or radiological interventions. Patients not achieving a pCR may be candidates for postoperative clinical trials exploring novel systemic treatments.

show abstract

Section: Predictive Role Of Pcrmentioning

confidence: 97%

Section: Role Of Surgery In Neoadjuvant Therapymentioning

confidence: 99%

Section: Definition Of Pcrmentioning

confidence: 99%

Section: Predictive Role Of Pcrmentioning

confidence: 99%

See 2 more Smart Citations

Current and future role of neoadjuvant therapy for breast cancer

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

“…Large or locally advanced breast cancers are currently treated with an anthracycline-based sequence followed by a taxane-based sequence at conventional doses (3). Dose-dense and dose-intensified chemotherapy has yielded encouraging results in TNBC (4,5). One phase III trial, "GeparOcto," is now comparing 2 different dose-dense, doseintensified regimens (6).…”

mentioning

confidence: 99%

¹⁸F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen

et al. 2015

View full text Add to dashboard Cite

Patients with triple-negative breast cancer (TNBC) have poor outcome when pathologic complete response (pCR) is not reached after neoadjuvant chemotherapy. Early prediction would be helpful. We evaluated the association between metabolic response after 2 cycles of neoadjuvant chemotherapy, pCR, and outcome in patients receiving 2 different anthracycline-based regimens (conventional and intensified). Methods: Of 77 consecutive TNBC patients, 23 received EC-D (4 cycles of epirubicin 1 cyclophosphamide followed by 4 cycles of docetaxel at conventional doses) and 55 received a dose-intensified, dose-dense concomitant regimen of epirubicin 1 cyclophosphamide (historically called SIM) for 6 cycles. PET/CT with 18 F-FDG was performed at baseline and after 2 cycles of neoadjuvant chemotherapy. The associations between clinical factors, biologic factors, early metabolic change, pCR, and event-free survival (EFS) were examined (log-rank test). Results: Of the 78 patients, 29 (37%) achieved pCR. The change in SUV max (ΔSUV max ) after 2 cycles was more pronounced in patients who achieved pCR (−72% vs. −42%; P , 0.0001). ΔSUV max was more pronounced under SIM than under EC-D (−68% vs. −35%, P 5 0.009), and there was a trend for a higher pCR rate (44% vs. 22%, P 5 0.078). Twenty-two patients relapsed and 10 of them died (median follow-up, 34 mo). pCR was associated with EFS (log-rank, P 5 0.001). ΔSUV max was also significantly associated with EFS both in patients receiving SIM (P 5 0.028) and in those receiving EC-D (P 5 0.021). The optimal ΔSUV max for predicting pCR and EFS was, however, specific to the treatment regimen. EFS was not associated with tumor grade (P 5 0.98), histologic subtype (P 5 0.17), or clinical stage (P 5 0.097). Conclusion: Early metabolic change during neoadjuvant chemotherapy can predict pathologic response and EFS in TNBC patients under different chemotherapy regimens. However, the metabolic response varies with the type of chemotherapy.

show abstract

A phase II study of preoperative capecitabine in women with operable hormone receptor positive breast cancer

et al. 2014

View full text Add to dashboard Cite

Conventional preoperative chemotherapy regimens have only limited efficacy in hormone receptor positive (HR+) breast cancer and new approaches are needed. We hypothesized that capecitabine, which is effective in metastatic breast cancer, may be an active preoperative treatment for HR+ breast cancer. Women with HR+, HER2-negative operable breast cancer received capecitabine, 2000 mg/m2 daily in divided doses for 14 days, followed by a 7-day rest period. Treatment was repeated every 21 days for a total of four cycles. The primary endpoint of the study was to determine the rate of pathological complete response (pCR). Because of slow accrual, the study was closed after 24 patients were enrolled. Three patients had a complete clinical response, and eight patients had a partial clinical response, for an overall clinical response rate of 45.8%. There were no cases of pCR. Of the 22 patients who had pathological response assessment by the Miller–Payne grading system, there were six grade 3 responses, and no grade 4 or 5 responses. Toxicity was manageable: the only grade 3 toxicities observed were one case each of diarrhea, palmar plantar erythrodysesthesia, hypokalemia, and mucositis. There was no association between baseline levels, or change in level from baseline to cycle 1, or from baseline to time of surgery, of thymidine phosphorylase (TYMP), thymidylate synthase (TYMS), dihydropyrimidine dehydrogenase (DPYD), or Ki67 and pathological, clinical, or radiographic response. Preoperative capecitabine is a well-tolerated regimen, but appears not lead to pCR when used as monotherapy in HR+ breast cancer.

show abstract

Impact of treatment characteristics on response of different breast cancer phenotypes: pooled analysis of the German neo-adjuvant chemotherapy trials

Cited by 240 publications

References 24 publications

Current and future role of neoadjuvant therapy for breast cancer

Current and future role of neoadjuvant therapy for breast cancer

¹⁸F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen

A phase II study of preoperative capecitabine in women with operable hormone receptor positive breast cancer

Contact Info

Product

Resources

About

Impact of treatment characteristics on response of different breast cancer phenotypes: pooled analysis of the German neo-adjuvant chemotherapy trials

Cited by 240 publications

References 24 publications

Current and future role of neoadjuvant therapy for breast cancer

Current and future role of neoadjuvant therapy for breast cancer

18F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen

A phase II study of preoperative capecitabine in women with operable hormone receptor positive breast cancer

Contact Info

Product

Resources

About

¹⁸F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen