Neoadjuvant Chemotherapy in Breast Cancer: Significantly Enhanced Response With Docetaxel

Smith, Ian C. P.; Heys, Steven Darryll; Hutcheon, A. W.; Miller, Iain D.; Payne, Simon; Gilbert, Fiona J; Ah‐See, A. K.; Eremin, O.; Walker, Leslie G.; Sarkar, T. K.; Eggleton, S. Peter; Ogston, Keith N.

doi:10.1200/jco.2002.20.6.1456

Cited by 410 publications

(175 citation statements)

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“…In addition to pathologic complete response, we also analyzed tumor volume reduction in all tumors, where we utilized a very standard and practical approach in estimating tumor volume reduction. We believe the method reported in this study is at least as objective, if not more, compared with other methods, [26][27][28] and yet quite simple compared with MD Anderson method 29 of estimating tumor volume reduction. This method made it possible to compare the differences between different tumor categories with confidence.…”

Section: Discussionmentioning

confidence: 70%

Semiquantitative hormone receptor level influences response to trastuzumab-containing neoadjuvant chemotherapy in HER2-positive breast cancer

et al. 2011

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Pathologic complete response to neoadjuvant chemotherapy without trastuzumab in hormone receptornegative/HER2 þ tumors is seen in 27-45% of cases. In contrast, estrogen receptor (ER) þ /HER2 þ tumors demonstrate pathologic complete response in B8% of cases and is generally limited to weak-to-moderate ER þ /HER2 þ tumors. It is speculated that addition of trastuzumab to neoadjuvant chemotherapy regimen will increase the pathologic complete response rates in all HER2 þ tumors. A list of HER2 þ patients who received neoadjuvant chemotherapy (with trastuzumab) in the years 2007-2010 was obtained from our hospital database. The 104 HER2 þ tumors were classified into three groups based on semiquantitative hormone receptor and HER2 results as follows: ERBB2 (ER-/PR-[H-score r10]/HER2 þ ), Luminal B-HER2 Hybrid (LBHH; weak to moderate ER þ [H-score 11-199]/HER2 þ ), and Luminal A-HER2 Hybrid (LAHH; strong ER þ [H-score Z200]/ HER2 þ ). Pathologic complete response was defined as absence of invasive carcinoma in the resection specimen and in the lymph nodes. Percentage tumor volume reduction was also calculated based on pretherapy size and detailed evaluation of the resection specimen. In all, 52% (25 of 48 cases) of ERBB2 tumors showed pathologic complete response, which was significantly higher than the pathologic complete response rate in LBHH (33%; 10 of 30) and LAHH (8%; 2 of 26) tumors. Average percentage tumor volume reduction was also highest in ERBB2 tumors (86%), followed by LBHH (74%) and LAHH (64%) tumors. We conclude that addition of trastuzumab to neoadjuvant chemotherapy regimen significantly increases the pathologic complete response rates in all HER2 þ tumors. However, the benefit of trastuzumab is highest in ER-negative tumors and progressively decreases with increase in tumor ER expression. This information can be utilized to counsel patients considered for neoadjuvant chemotherapy and the same principle could be applied in the adjuvant setting.

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Section: Discussionmentioning

confidence: 70%

Semiquantitative hormone receptor level influences response to trastuzumab-containing neoadjuvant chemotherapy in HER2-positive breast cancer

et al. 2011

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“…Preliminary results showed an overall response rate of 100% (complete response, 11%; partial response, 89%) with one patient (11%) showing a partial pathological response and one patient (11%) showing a minor pathological response. The Aberdeen Breast Study group is conducting a phase III trial in patients with stage III or LABC using docetaxel in sequential fashion following an anthracyclinebased cyclophosphamide/doxorubicin/vincristin/prednisolone (CVAP) regimen (Smith et al, 2002). In patients with tumours unresponsive to CVAP, docetaxel induced a 55% clinical response and a 2% pCR rates.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant docetaxel for operable breast cancer induces a high pathological response and breast-conservation rate

et al. 2003

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Docetaxel (Taxotere s ), alone or in combination with other anticancer agents, has proven efficacy in the first-and second-line treatment of metastatic breast cancer. This phase II study investigated the efficacy and tolerability of docetaxel as neoadjuvant chemotherapy in women with stage II -III primary operable breast cancer. Patients (n ¼ 88) were treated with six cycles of docetaxel at 100 mg m À2 every 21 days, followed by definitive surgery and radiotherapy. After six cycles of docetaxel, the overall clinical response rate was 68.4% (CI 95%: 58.1 -78.7%), including 19.0% complete remissions. Breast conservation was achieved in 72.4% of patients. A high pathological complete response (pCR) rate in breast was confirmed in 15 patients (19.8% (CI 95%: 10.8 -28.8%)) on Chevallier's classification restricted to breast and in 27 patients (35.5% (CI 95%: 24.7 -46.3%)) on Sataloff's classification. After a median follow-up of 30.8 months, 19 recurrences were documented with a median time to first recurrence of 17.3 months. Patients with stage III tumours had more recurrences than patients with stage II tumours (P ¼ 0.02). The principal toxicity of docetaxel is myelosuppression and 70.5% of patients developed grade III or IV neutropenia with 13.6% developing neutropenic sepsis. There was no case of severe cardiac toxicity, thrombocytopenia or any other serious adverse events. In conclusion, neoadjuvant docetaxel induces a high pCR and breast-conservation rate. Docetaxel monotherapy is a highly effective regimen that merits formal comparison with currently used combination regimens in a randomised phase III study.

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“…The improvement in the breast preservation rate may be based on an improvement in the clinical response rate. Two randomized Phase III studies 20,21 have demonstrated improvements in clinicopathologic response rates with the sequential addition of docetaxel to an anthracycline-containing preoperative regimen, i.e., the Aberdeen Breast Centre trial and the NSABP B-27 trial. In the Aberdeen trial, patients receiving docetaxel had an increased breast conservation rate (67% vs. 48%).…”

Section: Discussionmentioning

confidence: 99%

Breast‐conserving surgery after neoadjuvant anthracycline‐based chemotherapy for large breast tumors

Rouzier

Mathieu

Sidéris

et al. 2004

Cancer

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BACKGROUNDRandomized trials comparing neoadjuvant versus adjuvant chemotherapy show that primary chemotherapy allows more frequent breast‐preserving surgery even though no survival advantage has been demonstrated. The aim of the current study was to determine the predicting factors and the survival impact of breast conservation in patients with large breast tumors treated with neoadjuvant chemotherapy.METHODSBetween January 1987 and December 2001, 594 patients with invasive T2–3 breast carcinoma who were ineligible for breast‐conserving surgery (the mean initial tumor diameter was 49 mm) were treated with 3 or 4 courses of an anthracycline‐based primary chemotherapy, surgery, and radiotherapy. Various clinicopathologic factors were tested as possible predicting factors of breast‐preserving surgery. Survival analyses were performed to determine the implications of breast‐conserving surgery on outcome.RESULTSAfter primary chemotherapy, 287 (48%) patients were eligible for breast‐conserving surgery and 307 patients underwent a mastectomy. Initial tumor diameter > 5 cm, low histologic grade, lobular histology, and multicentricity were independent predicting factors of breast conservation ineligibility in the multivariate analysis (logistic regression). In the univariate survival analysis, a failure of breast‐preserving surgery was associated with a poor outcome. Local disease recurrence‐free survival rates were similar in patients treated with lumpectomy and mastectomy.CONCLUSIONSThe results reported in the current study suggested that initial diameter, histologic type and grade, and multicentricity are potential prechemotherapy predicting factors of breast conservation. When carefully selected, patients treated with breast conservation had a risk of local disease recurrence similar to the risk of chest wall disease recurrence after mastectomy. Cancer 2004. © 2004 American Cancer Society.

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Neoadjuvant Chemotherapy in Breast Cancer: Significantly Enhanced Response With Docetaxel

Abstract: NA DOC resulted in substantial improvement in responses to DOC.

Cited by 410 publications

References 38 publications

Semiquantitative hormone receptor level influences response to trastuzumab-containing neoadjuvant chemotherapy in HER2-positive breast cancer

Semiquantitative hormone receptor level influences response to trastuzumab-containing neoadjuvant chemotherapy in HER2-positive breast cancer

Neoadjuvant docetaxel for operable breast cancer induces a high pathological response and breast-conservation rate

Breast‐conserving surgery after neoadjuvant anthracycline‐based chemotherapy for large breast tumors

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