Clinical and Pathological Response to Neoadjuvant Chemotherapy with Different Chemotherapy Regimens Predicts the Outcome of Locally Advanced Breast Cancer

Overview

Journal Gland Surg

Publisher AME Publishing Company

Specialty Endocrinology

Date 2020 Nov 23

PMID 33224817

Citations 3

Authors

Shicong Tang

Ke Wang

Kai Zheng

Jiadong Liu

Hengyu Zhang

Mingjian Tan

Hongwan Li

Huimeng Li

Xin Tan

Dequan Liu

Rong Guo

Affiliations

Soon will be listed here.

Abstract

Background: This retrospective analysis was designed to research whether clinical response partial response (PR)/complete response (CR) and pathological response (PCR) to neoadjuvant chemotherapy can translate into prognosis benefit pathological response in patients with locally advanced breast cancer and whether different chemotherapy regimens will influence the outcomes.

Methods: One hundred and thirty-five patients with breast cancer patients who received neoadjuvant chemotherapy were included in the retrospective analysis. Patients were followed up strictly. Overall survival (OS) was evaluated by the Kaplan-Meier analysis. The comparison of the clinical and pathological characteristics and recurrence was performed using the carried out by chi-squared and Fisher's exact tests. Univariate and multivariate analyses were performed by the Cox regression analysis.

Results: Clinical response was strongly correlated with lymph nodes status (P=0.032). The OS comparison of pathological response between the pCR group and non-pCR groups did not exhibit statistically significant differences (P=0.400). A similar non-significant response result was observed in the comparison of clinical response between the PR/CR and SD/PD groups group (P=0.108). Univariate and multivariate analyses did not support clinical response (P=0.156 P=0.095 respectively) or pathological response (P=0.600 P=0.144 respectively) as the predictors of prognosis. There were no significant differences in either the comparison of the clinical response group it seems no statistically significance (P=0.496) or the comparison of the pathological response group (P=0.460). OS analyses across different neoadjuvant chemotherapy regimens demonstrated no significant differences (P=0.307). In the PR/CR and PD/SD comparison of every single regimen, there were no significant differences. However, for patients with PR/CR patients from the comparison of five regimens, namely, TAC, FAC, AC-T, AT and TCBP demonstrated a significant difference (P=0.022). In the group of patients with luminal A breast cancer, the result of the Fisher's exact test approached significant (P=0.059).

Conclusions: Neither PR/CR nor pCR can translate into long-term outcome benefit. PR/CR and PCR are not independent predictors in patients with advanced breast cancer. Patients who received a taxane + anthracycline regimen exhibited a higher recurrence rate than any other regimens, especially those patients with luminal A breast cancer.

Citing Articles

A real-world study of the effectiveness and safety of apatinib-based regimens in metastatic triple-negative breast cancer.

Huang W, Wang C, Shen Y, Chen Q, Huang Z, Liu J BMC Cancer. 2024; 24(1):39.

PMID: 38182995 PMC: 10768098. DOI: 10.1186/s12885-023-11790-6.

Addition of immune checkpoint inhibitors to chemotherapy versus chemotherapy alone in patients with triple-negative breast cancer: A systematic review and meta-analysis.

Gao X, Zhu Y, Wang P, Yu L, Ruan S, Shen M Cancer Med. 2023; 12(24):21873-21884.

PMID: 38063264 PMC: 10757081. DOI: 10.1002/cam4.6760.

Breast-Conserving Surgery in Triple-Negative Breast Cancer: A Retrospective Cohort Study.

Zhang H, Wang Z, Liu W, Wang P, Zhang X Evid Based Complement Alternat Med. 2023; 2023:5431563.

PMID: 36704213 PMC: 9873444. DOI: 10.1155/2023/5431563.

References

Kong X, Moran M, Zhang N, Haffty B, Yang Q . Meta-analysis confirms achieving pathological complete response after neoadjuvant chemotherapy predicts favourable prognosis for breast cancer patients. Eur J Cancer. 2011; 47(14):2084-90. DOI: 10.1016/j.ejca.2011.06.014. View

Eisenhauer E, Therasse P, Bogaerts J, Schwartz L, Sargent D, Ford R . New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2008; 45(2):228-47. DOI: 10.1016/j.ejca.2008.10.026. View

Bi Z, Liu J, Chen P, Liu Y, Zhao T, Wang C . Neoadjuvant chemotherapy and timing of sentinel lymph node biopsy in different molecular subtypes of breast cancer with clinically negative axilla. Breast Cancer. 2019; 26(3):373-377. DOI: 10.1007/s12282-018-00934-3. View

Caudle A, Yang W, Krishnamurthy S, Mittendorf E, Black D, Gilcrease M . Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection. J Clin Oncol. 2016; 34(10):1072-8. PMC: 4933133. DOI: 10.1200/JCO.2015.64.0094. View

Watanabe H, Okada M, Kaji Y, Satouchi M, Sato Y, Yamabe Y . [New response evaluation criteria in solid tumours-revised RECIST guideline (version 1.1)]. Gan To Kagaku Ryoho. 2009; 36(13):2495-501. View

Gluck S, de Snoo F, Peeters J, Stork-Sloots L, Somlo G . Molecular subtyping of early-stage breast cancer identifies a group of patients who do not benefit from neoadjuvant chemotherapy. Breast Cancer Res Treat. 2013; 139(3):759-67. DOI: 10.1007/s10549-013-2572-4. View

Korn E, Sachs M, McShane L . Statistical controversies in clinical research: assessing pathologic complete response as a trial-level surrogate end point for early-stage breast cancer. Ann Oncol. 2015; 27(1):10-5. PMC: 4701120. DOI: 10.1093/annonc/mdv507. View

Mieog J, van der Hage J, van de Velde C . Preoperative chemotherapy for women with operable breast cancer. Cochrane Database Syst Rev. 2007; (2):CD005002. PMC: 7388837. DOI: 10.1002/14651858.CD005002.pub2. View

Gianni L, Pienkowski T, Im Y, Roman L, Tseng L, Liu M . Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol. 2011; 13(1):25-32. DOI: 10.1016/S1470-2045(11)70336-9. View

10.

LeVasseur N, Sun J, Gondara L, Diocee R, Speers C, Lohrisch C . Impact of pathologic complete response on survival after neoadjuvant chemotherapy in early-stage breast cancer: a population-based analysis. J Cancer Res Clin Oncol. 2019; 146(2):529-536. DOI: 10.1007/s00432-019-03083-y. View

11.

Tryfonidis K, Senkus E, Cardoso M, Cardoso F . Management of locally advanced breast cancer-perspectives and future directions. Nat Rev Clin Oncol. 2015; 12(3):147-62. DOI: 10.1038/nrclinonc.2015.13. View

12.

Cortazar P, Zhang L, Untch M, Mehta K, Costantino J, Wolmark N . Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014; 384(9938):164-72. DOI: 10.1016/S0140-6736(13)62422-8. View

13.

Prowell T, Pazdur R . Pathological complete response and accelerated drug approval in early breast cancer. N Engl J Med. 2012; 366(26):2438-41. DOI: 10.1056/NEJMp1205737. View

14.

Gourd K . San Antonio Breast Cancer Symposium 2019. Lancet Oncol. 2019; 21(1):28. DOI: 10.1016/S1470-2045(19)30830-7. View

15.

Alba E, Lluch A, Ribelles N, Anton-Torres A, Sanchez-Rovira P, Albanell J . High Proliferation Predicts Pathological Complete Response to Neoadjuvant Chemotherapy in Early Breast Cancer. Oncologist. 2016; 21(6):778. PMC: 4912359. DOI: 10.1634/theoncologist.2015-0312erratum. View

16.

Russo L, Maltese A, Betancourt L, Romero G, Cialoni D, De la Fuente L . Locally advanced breast cancer: Tumor-infiltrating lymphocytes as a predictive factor of response to neoadjuvant chemotherapy. Eur J Surg Oncol. 2019; 45(6):963-968. DOI: 10.1016/j.ejso.2019.01.222. View

17.

Siegel R, Miller K, Jemal A . Cancer statistics, 2020. CA Cancer J Clin. 2020; 70(1):7-30. DOI: 10.3322/caac.21590. View

18.

OHalloran N, Lowery A, Curran C, McLaughlin R, Malone C, Sweeney K . A Review of the Impact of Neoadjuvant Chemotherapy on Breast Surgery Practice and Outcomes. Clin Breast Cancer. 2019; 19(5):377-382. DOI: 10.1016/j.clbc.2019.04.011. View

19.

Schettini F, Pascual T, Conte B, Chic N, Braso-Maristany F, Galvan P . HER2-enriched subtype and pathological complete response in HER2-positive breast cancer: A systematic review and meta-analysis. Cancer Treat Rev. 2020; 84:101965. PMC: 7230134. DOI: 10.1016/j.ctrv.2020.101965. View

20.

Chen S, Liu Y, Ouyang Q, Huang L, Luo R, Shao Z . Clinical and pathological response to neoadjuvant chemotherapy based on primary tumor reduction is correlated to survival in hormone receptor-positive but not hormone receptor-negative locally advanced breast cancer. Ann Surg Oncol. 2014; 22(1):32-9. DOI: 10.1245/s10434-014-3894-0. View