Locoregional Recurrence by Tumor Biology in Breast Cancer Patients after Preoperative Chemotherapy and Breast Conservation Treatment

Abstract

PurposeThe purpose of this study is to determine whether breast cancer subtype can affect locoregional recurrence (LRR) and ipsilateral breast tumor recurrence (IBTR) after neoadjuvant chemotherapy (NAC) and breast-conserving therapy (BCT).Materials and MethodsWe evaluated 335 consecutive patients with clinical stage II-III breast cancer who received NAC plus BCT from 2002 to 2009. Patients were classified according to six molecular subtypes: luminal A (hormone receptor [HR]+/HER2–/Ki-67 < 15%, n=113), luminal B1 (HR+/HER2–/Ki-67 ≥ 15%, n=33), luminal B2 (HR+/HER2+, n=83), HER2 with trastuzumab (HER2[T+]) (HR–/HER2+/use of trastuzumab, n=14), HER2 without trastuzumab (HER2[T–]) (HR–/HER2+, n=31), and triple negative (TN) (HR–/HER2–, n=61).ResultsAfter a median follow-up period of 7.2 years, 26 IBTRs and 37 LRRs occurred. The 5-year LRR-free survival rates were luminal A, 96.4%; B1, 93.9%; B2, 90.3%; HER2(T+), 92.9%; HER2(T–), 78.3%; and TN, 79.6%. The 5-year IBTR-free survival rates were luminal A, 97.2%; B1, 93.9%; B2, 92.8%; HER2(T+), 92.9%; HER2(T–), 89.1%; and TN, 84.6%. In multivariate analysis, HER2(T–) (IBTR: hazard ratio, 4.2; p=0.04 and LRR: hazard ratio, 7.6; p < 0.01) and TN subtypes (IBTR: hazard ratio, 6.9; p=0.01 and LRR: hazard ratio, 8.1; p < 0.01) were associated with higher IBTR and LRR rates. A pathologic complete response (pCR) was found to show correlation with better LRR and a tendency toward improved IBTR controls in TN patients (IBTR, p=0.07; LRR, p=0.03).ConclusionThe TN and HER2(T–) subtypes predict higher rates of IBTR and LRR after NAC and BCT. A pCR is predictive of improved IBTR or LRR in TN subtype.

Risk factors for locoregional disease recurrence after breast‐conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: An international collaboration and individual patient meta‐analysis

“…Second, the models in the current study did not take into account the molecular subtype of the tumors (except for ER and PR status) due to a paucity of data regarding HER2 and HER2‐directed therapy. Previous studies have suggested that patients with triple‐negative breast cancer are at an increased risk of LRR after NCT and BCT . The current study results confirm the pivotal role of ER status in the risk of LR and LRR.…”

“…Previous studies have suggested that patients with triple-negative breast cancer are at an increased risk of LRR after NCT and BCT. 26,27 The current study results confirm the pivotal role of ER status in the risk of LR and LRR. The potential role of HER2 status and the therapeutic effect of trastuzumab on the risk of LR or LRR in this setting could not be determined in this pooled data set because the majority of patients included were treated before the routine use of trastuzumab for patients with HER2-positive disease.…”

“…The potential role of HER2 status and the therapeutic effect of trastuzumab on the risk of LR or LRR in this setting could not be determined in this pooled data set because the majority of patients included were treated before the routine use of trastuzumab for patients with HER2‐positive disease. Prior studies have shown that HER2 positivity appears to be associated with a higher risk of LR or LRR after NCT and BCS; however, this association is less pronounced than the one observed with regard to ER negativity . Another limitation was the fact that some eligible cohorts were not included in the pooled data set because the primary investigators did not provide us with individual patient data.…”

Pathologic response after neoadjuvant chemotherapy predicts locoregional control in patients with triple negative breast cancer

“…Jwa et al evaluated LRR in a group of 335 patients with stage II-III breast cancer treated with NAC, breast-conserving surgery, and radiation, of whom 61 had TNBC. Patients with TNBC had higher ipsilateral breast tumor recurrence rates and higher LRR rates than the non-TNBC patients, and there was a trend toward better LRR and improved ipsilateral breast tumor recurrence with a pathologic complete response similar to our study 13 . Caudle et al similarly looked at response to NAC and outcome in a group of 595 patients at M D Anderson.…”

Pathologic Response After Neoadjuvant Chemotherapy Predicts Locoregional Control in Patients With Triple-Negative Breast Cancer

“…Patients with TNBC had higher ipsilateral breast tumor recurrence rates and higher LRR rates than the non-TNBC patients, and there was a trend toward better LRR and improved ipsilateral breast tumor recurrence with a pathologic complete response similar to our study. 13 Caudle et al similarly looked at response to NAC and outcome in a group of 595 patients at M D Anderson. Patients with Her2þ or TNBC biology with a poor response to NAC had worse LRRfree survival after breast-conserving therapy compared with other subtypes.…”