Locally Advanced Breast Cancer: MR Imaging for Prediction of Response to Neoadjuvant Chemotherapy—Results from ACRIN 6657/I-SPY TRIAL

Our increasing understanding of the molecular pathology of disease, particularly through genomic studies, has created significant opportunities for the development of therapeutics that specifically target discrete molecular subclasses, but equally, has generated substantial challenges in how to develop and implement these strategies. Variously termed personalised, stratified, individualised or precision medicine, the approach is centered on delivering the optimal therapy for an individual based on specific clinical and molecular features of their disease. The development of new therapeutics that target molecular mechanisms has driven considerable change and innovation in clinical trial strategies. We have made progress through improved efficiency and changes in clinical trial design, yet continued innovation through the modification of existing core paradigms in oncology drug development and clinical care are required to fully realise the promise of precision medicine.

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“…Examples of trials using these approaches include the BATTLE 30 and I-SPY series [31][32][33][34][35] of trials for lung and breast cancer.…”

Section: Principles and Evolution Of Clinical Trialsmentioning

confidence: 99%

Patient-centric trials for therapeutic development in precision oncology

Biankin

Piantadosi

Hollingsworth

2015

Nature

246

184

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“…Patients with genetic mutations associated with increased risk of BC also have an increased risk of contralateral BC and should undergo breast MRI for treatment planning (19). Breast MRI has also been shown to have better accuracy in detecting tumor response in patients undergoing NAC (20).…”

Section: Original Articlementioning

confidence: 99%

Impact of value based breast cancer care pathway implementation on pre-operative breast magnetic resonance imaging utilization

McCray¹,

Grobmyer²,

Pederson³

2017

Gland Surg.

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Background: Bilateral breast magnetic resonance imaging (MRI) is commonly used in the diagnostic workup of breast cancer (BC) to assess extent of disease and identify occult foci of disease. However, evidence for routine use of pre-operative MRI is lacking. Breast MRI is costly and can lead to unnecessary tests and treatment delays. Clinical care pathways (care paths) are value-based guidelines, which define management recommendations derived by expert consensus and available evidence based data. At Cleveland Clinic, care paths created for newly diagnosed BC patients recommend selective use of pre-operative MRI. We evaluated the number of pre-operative MRIs ordered before and after implementing an institution wide BC care paths in April 2014. Conclusions: Implementation of online BC care paths at our institution was associated with a decreased use of pre-operative MRI overall and in patients without a BC care path indication, driving value based care through the reduction of pre-operative breast MRIs.

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“…In response monitoring of patients receiving neoadjuvant chemotherapy (NAC), breast MRI has been shown to be the most accurate modality [25]. For this purpose, breast future science group MRI sequences can be used for either early response monitoring (i.e., after several cycles of chemotherapy), or after completion of the therapy to assess the presence of residual disease [26,27].…”

Section: Response Monitoring Of Neoadjuvant Chemotherapymentioning

confidence: 99%

Contrast-Enhanced Dual-Energy Mammography: A Promising New Imaging Tool in Breast Cancer Detection

Lalji

Lobbes

2014

Womens Health (Lond Engl)

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Contrast-enhanced dual-energy mammography (CEDM) is a promising new breast imaging tool for breast cancer detection. In CEDM, an iodine-based contrast agent is intravenously administered and subsequently, dual-energy mammography is performed. This results in a set of images containing both a regular mammogram and an image that contains contrast enhancement information. Preliminary studies have indicated that CEDM is superior to conventional mammography and might even match the diagnostic performance of breast MRI. In this review, the imaging technique, protocol and patient handling of CEDM is presented. Furthermore, an overview of current results on CEDM and potential future indications are outlined.

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Locally Advanced Breast Cancer: MR Imaging for Prediction of Response to Neoadjuvant Chemotherapy—Results from ACRIN 6657/I-SPY TRIAL

Abstract: MR imaging findings are a stronger predictor of pathologic response to NACT than clinical assessment, with the greatest advantage observed with the use of volumetric measurement of tumor response early in treatment.

Cited by 415 publications

References 17 publications

Patient-centric trials for therapeutic development in precision oncology

Patient-centric trials for therapeutic development in precision oncology

Impact of value based breast cancer care pathway implementation on pre-operative breast magnetic resonance imaging utilization

Contrast-Enhanced Dual-Energy Mammography: A Promising New Imaging Tool in Breast Cancer Detection

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