Pathologic Complete Response After Neoadjuvant Chemotherapy and Long-Term Outcomes Among Young Women With Breast Cancer

Spring, Laura; Greenup, Rachel A.; Niemierko, Andrzej; Schapira, Lidia; Haddad, Stephanie; Jimenez, Rachel; Coopey, Suzanne B.; Taghian, Alphonse G.; Hughes, Kevin S.; Isakoff, Steven J.; Ellisen, Leif W.; Smith, Barbara L.; Specht, Michelle C.; Moy, Beverly; Bardia, Aditya

doi:10.6004/jnccn.2017.0158

Cited by 109 publications

(88 citation statements)

References 23 publications

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“…Previous reports by our group (Acevedo et al, 2015) and by others (Rouzier et al, 2005) suggest the use of BC subtypes as a pCR predictor factor; also a post NAC pCR is associated to OS (Spring et al, 2017).…”

Section: Discussionmentioning

confidence: 55%

The Neutrophil to Lymphocyte Ratio Predicts the Response to Neoadjuvant Chemotherapy in Luminal B Breast Cancer

Rivas

Acevedo

Domı́nguez

et al. 2019

Asian Pac J Cancer Prev

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Objective: Tumor response to neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients is a predictor for overall survival. The aim of our study was to determine a relationship between the neutrophil to lymphocyte ratio (NLR) prior to NAC, BC subtypes and the probability of a pathologic complete response (pCR). Materials and Methods: Medical records were collected retrospectively from Centro de Cancer at Red Salud UC-Christus. Clinical data collected included peripheral blood cell counts, BC subtype at diagnosis and the pathology report of surgery after chemotherapy. Results: A total of 88 patients were analyzed. Approximately, a 25% had a pCR, and displayed a significant correlation between BC subtype and pCR (p= 0.0138 Chi2); this was more frequent in epidermal growth factor receptor type 2 (HER2) enriched subtype patients (54%). Luminal B BC patients with a pCR had significantly lower NLR levels (t test, p= 0.0181). Conclusions: HER2-enriched tumors had a higher probability of pCR. In Luminal B tumors, NLR had a statistically significant relationship with the probability of pCR. In this subtype, NLR could be a useful biomarker to predict tumor response to NAC. Further studies including other clinical parameters for systemic inflammation such as platelet counts, intratumoral NLR or body mass index could help identify patients that would get the most benefit from NAC.

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Section: Discussionmentioning

confidence: 55%

The Neutrophil to Lymphocyte Ratio Predicts the Response to Neoadjuvant Chemotherapy in Luminal B Breast Cancer

Rivas

Acevedo

Domı́nguez

et al. 2019

Asian Pac J Cancer Prev

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“…A retrospective analysis of 170 women aged ≤40 years treated with NAC also observed a high rate of recurrence (29.4%) and mortality (22.9%). 15 It is likely that these women would benefit from adjuvant treatment to improve outcomes, and several trials have evaluated escalation of adjuvant therapy. [16][17][18] The recently published CREATE-X trial 19 evaluated 910 patients with HER2-negative breast cancer who had residual invasive disease or LN metastases after NAC.…”

Section: Discussionmentioning

confidence: 99%

Outcomes Following Neoadjuvant Chemotherapy for Breast Cancer in Women Aged 40 Years and Younger: Impact of Pathologic Nodal Response

Kozak¹,

Jacobson²,

Eyben³

et al. 2018

J Natl Compr Canc Netw

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We sought to evaluate whether pathologic nodal response was predictive of outcomes in women aged ≤40 years with breast cancer treated with neoadjuvant chemotherapy (NAC). A total of 220 patients treated with NAC between 1991 and 2015 were retrospectively reviewed. Pathologic complete response (pCR) was defined as no evidence of residual invasive tumor in the breast and lymph nodes (LNs) (ypT0/Tis ypN0); partial response if there was no tumor in the LNs but residual tumor in the breast (ypT+ ypN0) or residual tumor in the LNs (ypT0/Tis ypN+); and limited response if there was residual tumor in both the breast and the LNs (ypT+ ypN+). Kaplan-Meier and Cox proportional hazards analyses were performed to identify factors predictive for overall survival (OS). A total of 155 patients were included. Following NAC, 39 patients (25.2%) achieved pCR, 57 (36.8%) achieved a partial response (either ypT+ ypN0 or ypT0/Tis ypN+), and 59 (38.1%) had a limited response. A total of 22 patients (14.2%) experienced local failure, 20 (12.9%) experienced regional failure, and 59 (38.1%) experienced distant failure. Median OS for patients who achieved pCR was not reached, and was significantly worse for patients who had residual disease in the breast and/or LNs (<.001). No difference in OS was seen among patients who had residual disease in the breast alone versus those who remained LN-positive (97 vs 83 months, respectively; =.25). Subset analysis did not reveal differences in OS based on year of treatment or cN1 disease at the time of initial diagnosis. Women aged ≤40 years who achieved pCR had excellent outcomes; however, those who achieved a pathologic response in the LNs but had residual disease in the breast continued to have outcomes similar to those who remained LN-positive.

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“…The reduction in tumor burden in response to neoadjuvant therapy translates to significantly higher survival rates. 4 The current standard of care mandates surgery following NACT, even in the presence of radiological complete response, although it is possible that omission of surgery is safe in some cases. 5 Nevertheless, patients not achieving complete tumor regression following standard NACT are candidates for additional therapy.…”

Section: Introductionmentioning

confidence: 99%

Circulating breast-derived DNA allows universal detection and monitoring of localized breast cancer

Moss¹,

Zick

Grinshpun

et al. 2020

Annals of Oncology

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Background: Tumor-derived circulating cell-free DNA (cfDNA) is present in the plasma of individuals with cancer. Assays aimed at detecting common cancer mutations in cfDNA are being developed for the detection of several cancer types. In breast cancer, however, such assays have failed to detect the disease at a sensitivity relevant for clinical use, in part due to the absence of multiple common mutations that can be co-detected in plasma. Unlike individual mutations that exist only in a subset of tumors, unique DNA methylation patterns are universally present in cells of a common type and therefore may be ideal biomarkers. Here we describe the detection and quantification of breast-derived cfDNA using a breast-specific DNA methylation signature. Patients and methods: We collected plasma from patients with localized breast cancer before and throughout treatment with neoadjuvant chemotherapy and surgery (N ¼ 235 samples). Results: Pretreatment breast cfDNA was detected in patients with localized disease with a sensitivity of 80% at 97% specificity. High breast cfDNA levels were associated with aggressive molecular tumor profiles and metabolic activity of the disease. During neoadjuvant chemotherapy, breast cfDNA levels decreased dramatically. Importantly, the presence of breast cfDNA towards the end of the chemotherapy regimen reflected the existence of residual disease. Conclusion: We propose that breast-specific cfDNA is a universal and powerful marker for the detection and monitoring of breast cancer.

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Pathologic Complete Response After Neoadjuvant Chemotherapy and Long-Term Outcomes Among Young Women With Breast Cancer

Cited by 109 publications

References 23 publications

The Neutrophil to Lymphocyte Ratio Predicts the Response to Neoadjuvant Chemotherapy in Luminal B Breast Cancer

The Neutrophil to Lymphocyte Ratio Predicts the Response to Neoadjuvant Chemotherapy in Luminal B Breast Cancer

Outcomes Following Neoadjuvant Chemotherapy for Breast Cancer in Women Aged 40 Years and Younger: Impact of Pathologic Nodal Response

Circulating breast-derived DNA allows universal detection and monitoring of localized breast cancer

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