Oestrogen receptor status, pathological complete response and prognosis in patients receiving neoadjuvant chemotherapy for early breast cancer

Abstract

The aim of this study was to ascertain if oestrogen receptor (ER) status predicts for pathological complete response (pCR) to neoadjuvant chemotherapy in operable breast cancer, and the effects of pCR on survival. Using a single-institution database, 435 patients were identified, who received neoadjuvant chemotherapy for operable breast cancer and were eligible for the analysis. Patients whose tumours were ER negative were more likely to achieve a pCR than patients who were ER positive (21.6 vs 8.1%, Po0.001). Owing to a strong correlation between ER status and grade, these variables were not shown to be independent predictors of pCR. Overall survival (OS) was better in those patients who achieved a pCR compared to those who did not (5-year OS 91 vs 73%; P ¼ 0.02). This was still the case when only patients with ER-negative tumours were examined (5-year OS 90 vs 52%, P ¼ 0.005), but not in the subset of patients with ER-positive tumours (5-year OS 93 vs 79%; P ¼ 0.3). Therefore, patients with ERnegative tumours were found to be more likely to achieve a pCR to neoadjuvant chemotherapy than those with ER-positive tumours, and pathological response did not have prognostic significance in patients with ER-positive tumours.

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

“…Patients with ER-negative tumors are more likely to achieve a pCR after neoadjuvant chemotherapy than those with ER-positive tumors. 26 This also was demonstrated in a retrospective review, which indicated that the pCR rate in studies with anthracycline-based chemotherapies ranged from 1.2% to 14.3% in patients with hormone receptor-positive tumors and from 7.1% to 54.5% in patients with hormone receptor-negative tumors. However, in that analysis, the HER2 status of tumors was not known.…”

Preoperative chemotherapy is safe in early breast cancer, even after 10 years of follow-up; clinical and translational results from the EORTC trial 10902

“…One of the oldest (validated) prognostic and predictive factor is the ER. It was demonstrated that pCR is more likely to occur in patients with ER negative than ER positive disease [30][31][32][33]. Therefore, preoperative chemotherapy may not be the most appropriate preoperative approach for patients with ER positive disease.…”

Increasing steroid hormone receptors expression defines breast cancer subtypes non responsive to preoperative chemotherapy

“…It was recently shown that the pathological complete remission (pCR) rate was significantly higher following PCT for patients with tumors not expressing estrogen (ER) and progesterone receptor (PgR), compared with the receptor positive cohort [4][5][6]. Regardless of the significantly higher incidence of pCR for patients with ER and PgR absent disease, the 5-year disease-free survival (DFS) was significantly worse for this cohort compared with the low/positive expression cohort in several studies [5][6][7][8]. In these studies analyses were performed based on a so-called 'receptor-negative grouping', which combines receptor-absent disease with that expressing low receptor levels, and 'receptor positive grouping' which combines all patients with tumors expressing ER and/or PgR in C10% of the cells.…”