Preoperative Chemotherapy: Updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27

Rastogi, Priya; Anderson, Stewart J.; Bear, Harry D.; Geyer, Charles E.; Kahlenberg, Morton S.; Robidoux, André; Margolese, Richard G.; Hoehn, James L.; Vogel, Victor G.; Dakhil, Shaker R.; Tamkus, Deimante; King, Karen; Pajon, Eduardo R.; Wright, Mary Johanna; Robert, Jean; Paik, Soonmyung; Mamounas, Eleftherios P.; Wolmark, Norman

doi:10.1200/jco.2007.15.0235

Cited by 1,593 publications

(1,311 citation statements)

References 37 publications

Supporting

Mentioning

1,170

Contrasting

Unclassified

Order By: Relevance

“…An alternative and more rapid approach is to evaluate the predictive value of a prognostic marker for chemosensitivity in the neoadjuvant setting. Here, the pathological response can be used as endpoint, since the achievement of pCR has gained wide acceptance as a predictor of a good long-term prognosis [20,21]. In this report a series of 167 patients with stage II and III primary invasive breast cancer who received neoadjuvant chemotherapy is described.…”

Section: Discussionmentioning

confidence: 99%

The 70-gene signature as a response predictor for neoadjuvant chemotherapy in breast cancer

Straver

Glas

Hannemann

et al. 2009

Breast Cancer Res Treat

226

118

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

The 70-gene signature as a response predictor for neoadjuvant chemotherapy in breast cancer

Straver

Glas

Hannemann

et al. 2009

Breast Cancer Res Treat

226

118

View full text Add to dashboard Cite

“…12,17 The National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18 trial demonstrated that, in a population with predominantly T2 disease ( 60%), neoadjuvant chemotherapy-associated tumor shrinkage altered the BC surgical intervention from a 60%/40% lumpectomy/mastectomy ratio after adjuvant chemotherapy to a 68%/32% lumpectomy/mastectomy ratio. 13 More recently, in a group of patients with mostly T3/T4 disease (80%), those with HER2-positive disease who received a neoadjuvant trastuzumab-based regimen exhibited a mean decrease in tumor size from 7.75 cm at baseline to 2.20 cm after neoadjuvant therapy, resulting in a 43.7% lumpectomy rate (unpublished data). In addition to treating detectable disease before surgery, neoadjuvant chemotherapy provides the earliest chance to treat micrometastatic disease, saving time that potentially could be lost to local treatment.…”

Section: Neoadjuvant Chemotherapy For the Treatment Of Breast Cancermentioning

confidence: 98%

“…In addition, among patients who were event-free for 5 years, regardless of age, DFS was greater in patients who received neoadjuvant therapy compared with the postoperative therapy group (HR, 0.81; P ¼ .053). 13 One important caveat with neoadjuvant chemotherapy, however, has been raised by a meta-analysis that compared the outcomes of neoadjuvant versus adjuvant treatment in BC. That analysis demonstrated an increase in locoregional failure for patients who had received neoadjuvant therapy if they subsequently did not undergo surgery and, instead, received radiotherapy.…”

Section: Neoadjuvant Chemotherapy For the Treatment Of Breast Cancermentioning

confidence: 99%

“…Trastuzumab may provide additional clinical benefit by increasing the rate of breast conservation, decreasing the rate of distant metastases, and increasing the likelihood of achieving a pathologic complete response (pCR). 12,13 In this article, we review efficacy and safety data from studies of patients with HER2-positive BC who received neoadjuvant trastuzumab-based therapy. Studies were identified from a literature search using the PubMed database and congress Web sites from 2002 to 2008.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Trastuzumab‐based neoadjuvant therapy in patients with HER2‐positive breast cancer

Chang

2010

Cancer

View full text Add to dashboard Cite

Overexpression, or gene amplification, of the human epidermal growth factor receptor 2 (HER2) is evident in 20% to 25% of breast cancers. The biologic agent trastuzumab is an HER2-targeted monoclonal antibody that inhibits the proliferation of tumor cells and induces tumor cell death through multiple mechanisms of action. Currently, trastuzumab is approved for use in the adjuvant and metastatic settings. Trials combining trastuzumab with neoadjuvant chemotherapy suggest that patients with HER2-positive breast cancer also may benefit from preoperative trastuzumab. For this article, the author reviewed efficacy and safety data from key studies of patients who received neoadjuvant trastuzumab-based therapy. Studies were identified from literature searches of publication and congress databases. The results of 3 large phase 3 trials (the M. D. Anderson Cancer Center neoadjuvant trastuzumab trial, the Neoadjuvant Herceptin [NOAH] trial, and the German Breast Group/Gynecologic Oncology Study Group ''GeparQuattro'' trial) demonstrated that, compared with chemotherapy alone, neoadjuvant trastuzumab plus chemotherapy significantly increased pathologic complete response rates to as high as 65%. Improvements in disease-free, overall, and event-free survival also were reported in the NOAH trial. In addition to demonstrated efficacy, a low incidence of cardiac dysfunction suggests that neoadjuvant trastuzumab is both effective and well tolerated. Similar results have been reported in a range of phase 2 studies using different trastuzumab-based regimens. These encouraging data led the National Comprehensive Cancer Network to recommend treating patients who have operable, locally advanced, HER2-positive breast cancer with neoadjuvant paclitaxel plus trastuzumab followed by 5-fluorouracil, epirubicin, and cyclophosphamide plus trastuzumab. Cancer 2010;116:2856-67. V C 2010 American Cancer Society.KEYWORDS: neoadjuvant, trastuzumab, HER-2, chemotherapy, biologic, breast cancer, breast conservation surgery, lymph node management.Breast cancer (BC) is the most frequently diagnosed form of cancer among women in the United States. 1 Of the various subtypes of BC, tumors that have gene amplification or protein overexpression of human epidermal growth factor receptor 2 (HER2) are among the most aggressive and are associated with poor clinical outcomes compared with tumors that do not have HER2 overexpression. 2-4 Of the total number of patients diagnosed with BC in the United States, 20% to 25% will have tumors that exhibit HER2 gene amplification or protein overexpression. 2,5,6 Trastuzumab (Herceptin), a humanized, monoclonal antibody that blocks the activity of HER2, is the only anti-HER2 agent that is approved for adjuvant therapy in patients who have HER2-positive disease with either positive or negative lymph node status, estrogen receptor (ER)/progesterone receptor (PR)-negative disease, or a high-risk feature, either in combination with chemotherapy or as a single agent after chemotherapy. Adjuvant trastuzumab significantly imp...

show abstract

“…During NAC the treatment response may be monitored in vivo to obtain individualized treatment, i.e., by modifying ineffective treatments. The response to breast cancer chemotherapy has been shown to correlate with long-term outcome, although only complete pathologic response (pCR) has a major impact on disease free survival (DFS) and overall survival (OS) (2). Although pCR is the gold standard and associated with improved DFS and OS, there is also evidence for improved outcomes for clinical responders (3).…”

mentioning

confidence: 99%

Diffusion‐weighted and dynamic contrast‐enhanced MRI in evaluation of early treatment effects during neoadjuvant chemotherapy in breast cancer patients

Jensen¹,

Garzón²,

Heldahl³

et al. 2011

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Purpose: To use dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MRI at 3 Tesla (T) for early evaluation of treatment effects in breast cancer patients undergoing neoadjuvant chemotherapy (NAC), and assess the reliability of DW-MRI.Materials and Methods: DW-and DCE-MRI acquisitions of 15 breast cancer patients were performed before and after one cycle of NAC. MRI tumor diameter and volume, apparent diffusion coefficient (ADC) and kinetic parameters (K trans , v e ) were derived. The reliability of ADC before NAC was assessed. Changes in MRI parameters after NAC were analyzed, and logistic regression analysis was used to find the best predictors for pathologic response. Results:The reliability for ADC values was high, with intraclass correlation coefficient of 0.84 (P ¼ 0.001). After one cycle of NAC, MRI tumor diameter (8%, P ¼ 0.005) and tumor volume (30%, P ¼ 0.008) was reduced for all patients, while ADC mean values increased (0.12 mm 2 /s, P ¼ 0.008). The best predictor for treatment response was a change in MRI tumor diameter with mean error rate of 0.167 (13% for responders, 5% for nonresponders, P ¼ 0.291).Conclusion: Changes in MRI derived tumor diameter and ADC after only one cycle of NAC could provide a valuable tool for early evaluation of treatment effects in breast cancer patients.

show abstract

Preoperative Chemotherapy: Updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27

Abstract: B-18 and B-27 demonstrate that preoperative therapy is equivalent to adjuvant therapy. B-27 also showed that the addition of preoperative taxanes to AC improves response.

Cited by 1,593 publications

References 37 publications

The 70-gene signature as a response predictor for neoadjuvant chemotherapy in breast cancer

The 70-gene signature as a response predictor for neoadjuvant chemotherapy in breast cancer

Trastuzumab‐based neoadjuvant therapy in patients with HER2‐positive breast cancer

Diffusion‐weighted and dynamic contrast‐enhanced MRI in evaluation of early treatment effects during neoadjuvant chemotherapy in breast cancer patients

Contact Info

Product

Resources

About