Serial MRI scans help in assessing early response to neoadjuvant chemotherapy and tailoring breast cancer treatment

Fatayer, Hiba; Sharma, Nisha; Manuel, DD; Kim, Baek; Keding, Ada; Perren, Timothy J.; Velikova, Galina; Lansdown, Mark; Shaaban, Abeer M.; Dall, B.

doi:10.1016/j.ejso.2016.03.019

Cited by 13 publications

(11 citation statements)

References 23 publications

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“…The trial aim is to evaluate the acceptability of a post-neoadjuvant treatment recommendation based on pCR, i.e., if pCR is achieved, no additional chemotherapy is recommended, but with continuation with trastuzumab and pertuzumab. Some studies showed that imaging such as PET scans and MRI or serial breast core needle biopsies during NAT could not predict pCR with enough accuracy to omit surgery [ 50 , 51 ]. As the MRI accuracy in predicting residual disease is greater for higher-grade tumors, in TRAIN-3 (NCT03820063), the benefit of a shorter duration of chemotherapy followed by an earlier surgery is being evaluated for breast cancer patients with an early complete radiologic response.…”

Section: Ongoing Trials Of Risk Tailored Therapy In Her2-positive Ebcmentioning

confidence: 99%

Evolving Role of Risk Tailored Therapy in Early Stage HER2-Positive Breast Cancer: A Canadian Perspective

2022

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The advent of HER2-targeted therapies has led to an important shift in the management of HER2-positive early breast cancer. However, initial treatment approaches apply uniform treatment regimens to all patients, with significant treatment-related and financial toxicities for both the patient and the health care system. Recent data demonstrates that for many patients, the chemotherapy backbone, duration and nature (mono- versus dual-targeted therapy) of the HER2 blockade can be better targeted to an individual patient’s risk of recurrence. We will provide a review of current data supporting risk tailored therapy in early stage HER2-positive breast cancer along with key completed and ongoing Canadian and international risk tailored trials. Neoadjuvant systemic therapy should now be considered for patients with clinical stage 2 disease, with greater use of non-anthracycline based chemotherapy regimens. Patients with residual disease following neoadjuvant therapy should be considered for escalated treatment with adjuvant T-DM1. Patients with stage I disease can often be managed with upfront surgery and evidence-based de-escalated adjuvant chemotherapy regimens. The modest benefit of 12- versus 6 months of adjuvant HER2 therapy and/or dual adjuvant HER2 therapy should be carefully weighed against the toxicities. All patients with HER2-positive breast cancer should be enrolled in ongoing risk tailored treatment trials whenever possible. Increasing data supports risk tailored therapy in early stage HER2-positive breast cancer in place of the routine application of aggressive and toxic systemic therapy regimens to all patients. While much progress has been made towards treatment de-escalation in appropriate patients, more is needed, as we highlight in this review. Indeed, Canadian-led clinical trials are helping to lead these efforts.

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Section: Ongoing Trials Of Risk Tailored Therapy In Her2-positive Ebcmentioning

confidence: 99%

Evolving Role of Risk Tailored Therapy in Early Stage HER2-Positive Breast Cancer: A Canadian Perspective

2022

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“…Response monitoring at MR imaging was based on Leeds modified response evaluation criteria in solid tumors, with tumor size and enhancement characteristics taken into account (10). Radiologic response was classified as progression (progressive lesions or 25% increase in tumor bulk), stable (no change to appearance of tumor), minimal (25%-50% reduction in diameter of main tumor bulk and no improvement in enhancement curve), partial (.50% reduction in diameter of main tumor bulk or 25%-50% reduction in diameter of main tumor bulk and improved enhancement curve), or complete (no radiologic evidence of any previously documented lesions).…”

Section: Data Collection and Decision Makingmentioning

confidence: 99%

Human Epidermal Growth Factor 2–positive Breast Cancer with Mammographic Microcalcification: Relationship to Pathologic Complete Response after Neoadjuvant Chemotherapy

2018

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Purpose To determine the relationship between the presence or absence of mammographic calcifications in human epidermal growth factor receptor 2 (HER2)-positive breast cancers and pathologic complete response (pCR) to neoadjuvant chemotherapy and to determine other tumor and clinical characteristics that may be predictive of such a response. Materials and Methods A database of all patients with HER2-positive breast cancer who underwent neoadjuvant chemotherapy between 2007 and 2015 was retrospectively reviewed. Patient demographic characteristics, mammographic appearance, molecular subtype of cancer (luminal or nonluminal), radiologic response (based on breast magnetic resonance images), surgery, and pathologic response to treatment were recorded. Inter- and subgroup comparison was performed for presence of mammographic microcalcification and cancer subtype by using Mann-Whitney and χ tests and logistic regression. Results A total of 111 patients with a median age of 49 years (interquartile range, 40-57 years) were evaluated. Of these, 64.9% (72 of 111) had mammographic microcalcifications, 63.1% (70 of 111) had luminal B cancer, and 36.9% (41 of 111) had nonluminal HER2-positive cancer. Radiologic response to neoadjuvant chemotherapy was observed in 70.3% (78 of 111) of patients. Surgery was performed in 97.3% (108 of 111) of patients, and 30.6% (34 of 111) of patients underwent breast conservation. pCR was observed in 33.3% (37 of 111) of patients; 16.2% (18 of 111) showed residual ductal carcinoma in situ and 50.5% (56 of 111) had residual invasive disease. The pCR rate was the same (P = .21) in patients with mammographic microcalcification (29.2% [21 of 72]) as in those without calcification (41.0% [16 of 39]). The pCR rate in patients with nonluminal HER2-positive cancers (46.3% [19 of 41]) was higher (P = .01) than in those with luminal B cancers (25.7% [18 of 70]). pCR was associated with nonluminal HER2-positive subtype (odds ratio, 5.4; 95% confidence interval: 1.8, 16.0; P = .01) and complete radiologic response (odds ratio, 20.4; 95% confidence interval: 3.3, 126.6; P = .01). Conclusion Patients with HER2-positive cancer and mammographic microcalcification can achieve pCR after neoadjuvant chemotherapy. Nonluminal HER2-positive subtype and complete radiologic response are predictors of pCR.

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“… 3 Early assessment of responder to NACT can assist clinicians in adjusting therapy to avoid toxic side effects, increase rates of pCR, and improve disease-free survival and overall survival. 5 , 6 , 7 Thus, early prediction of pCR to NACT is of great clinical significance.…”

Section: Introductionmentioning

confidence: 99%

Early prediction of treatment response to neoadjuvant chemotherapy based on longitudinal ultrasound images of HER2-positive breast cancer patients by Siamese multi-task network: A multicentre, retrospective cohort study

Liu

Wang

et al. 2022

eClinicalMedicine

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Serial MRI scans help in assessing early response to neoadjuvant chemotherapy and tailoring breast cancer treatment

Cited by 13 publications

References 23 publications

Evolving Role of Risk Tailored Therapy in Early Stage HER2-Positive Breast Cancer: A Canadian Perspective

Evolving Role of Risk Tailored Therapy in Early Stage HER2-Positive Breast Cancer: A Canadian Perspective

Human Epidermal Growth Factor 2–positive Breast Cancer with Mammographic Microcalcification: Relationship to Pathologic Complete Response after Neoadjuvant Chemotherapy

Early prediction of treatment response to neoadjuvant chemotherapy based on longitudinal ultrasound images of HER2-positive breast cancer patients by Siamese multi-task network: A multicentre, retrospective cohort study

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