Pathological complete response in early breast cancer patients undergoing neoadjuvant chemotherapy: Focus on Ki-67 and molecular subtypes

Abstract

Background: Breast cancer is the most common cancer in Indian women. Triple negative breast cancer (TNBC) is associated with poor prognosis at any stage of diagnosis. It is an aggressive disease with a 5-year survival rate of 77% compared to 93% for other subtypes. Prevalence of TNBC in India is higher compared to western populations, making it an important target for early detection and treatment. Potential superiority of dose-dense chemotherapy in comparison with conventional regimen has been recently demonstrated in a meta-analysis in 2017 across various subsets of breast cancer. Aim of this study was to analyse survival outcomes in TNBC treated with dose dense chemotherapy at a tertiary care centre in India. Methods: Retrospective analysis of patients diagnosed with TNBC stage I-III in last 8 years treated with 2 weekly dose dense AC regimen (adriamycin at 60mg/m 2 and cyclophosphamide at 600mg/m 2 for 4 cycles followed by 2 weekly Paclitaxel at175 mg/m 2 for 4 cycles or weekly Paclitaxel at 80 mg/m 2 for 12 cycles) with growth factor support in adjuvant or neoadjuvant (NACT) setting. Locally advanced breast cancer (LABC) was defined as T > 5cm and N2 disease. Kaplan-Meier method and log rank test were used to estimate survival functions. Results: 97 patients with ER, PR and Her2neu receptor negative status were evaluated. Median age at diagnosis was 44 years (range 26 -68 years). 56.7% had stage II disease, 36% stage III and rest stage I (7.2%). Disease free survival (DFS) rate 6 SE at 2 years and 5 years was 90% 6 3% and 75% 6 5% respectively. Overall survival (OS) rate 6 SE at 5 years was 82% 6 6%. 24 patients received NACT out of which 12 (50%) patients had pathCR. The DFS rate did not differ significantly between adjuvant and neoadjuvant subgroups. Early breast cancer and LABC subgroups had a statistically significant difference in DFS rates (p ¼ 0.0002). Conclusions: To our knowledge, this is the first study in India to evaluate survival outcomes of dose dense therapy in TNBC. The improved DFS (75%) and OS (82%) in this high risk subgroup are very promising, especially in patients with early disease. We advocate use of dose dense regimen in all patients of TNBC in curative setting.

Development of Gene Expression-Based Random Forest Model for Predicting Neoadjuvant Chemotherapy Response in Triple-Negative Breast Cancer

“…Due to the aggressive tumor growth in TNBC, NeoAdjuvant Chemotherapy (NAC), which refers to preoperative chemotherapy, is often considered as a first-line treatment for TNBC patients. The main treatment goal of NAC is to achieve a pathological complete response (pCR) and pCR is defined as the complete disappearance of all invasive carcinoma cells in the breast and axillary lymph nodes, which is assessed pathologically in the resected tissue after neoadjuvant chemotherapy [ 10 ]. Patients who do not achieve pCR are refer to as having Residual Disease (RD).…”

Metformin as an adjuvant option for systemic treatment of breast cancer

“…That can be reason of disability reduce after surgical treatment, lower levels of cardiotoxicity and neurotoxicity, which can reduce the burden on the financial health care system of the country, government programs or insurance systems and financial toxicity for the patient. This is the most successful justification for changes in the preoperative tactics of treating patients with breast cancer [9,52]. Thus, among the group of На умовах ліцензії CC BY 4.0 patients who received NA treatment, the following results were achieved: no stage change =29.1%, stage reduction =7.9%, total pCR=19.2%.…”