The Role of Immunohistochemistry in Breast Cancer Patients Treated With Neoadjuvant Chemotherapy: An Old Tool With an Enduring Prognostic Value

Sánchez-Muñoz, Alfonso; Plata-Fernández, Yessica; Fernández, Margarita; Jaén-Morago, A.; Fernández-Navarro, Mónica; Torre-Cabrera, C. de la; Ramírez-Tortosa, César L.; Lomas-Garrido, M.; Llácer, Casilda; Navarro-Perez, Victor; Conejo, Emilio Alba; Sánchez‐Rovira, Pedro

doi:10.1016/j.clbc.2012.11.006

Cited by 25 publications

(16 citation statements)

References 31 publications

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“…The overall pCR rate was 13.3%, similar to that in another study of Korean breast cancer patients [12]. The pCR rates for the HE and TN subtypes were significantly higher than for the luminal subtypes; in the luminal subtypes, the pCR rate of the LB group was higher than that of the LA group, which is consistent with other studies [13,14]. Age was not associated with pCR in the present study.…”

Section: Discussionsupporting

confidence: 91%

“…It has not been elucidated whether the HE or TN subtype is more responsive to NACT without trastuzumab, an anti-HER2 monoclonal antibody. The HE subtype was more responsive in some studies including this one, whereas the TN subtype was more responsive in others [13,14]. …”

Section: Discussionmentioning

confidence: 93%

“…Since NACT was first used to treat breast cancer, a considerable number of studies have demonstrated that the expression of HRs and/or HER2 is associated with the NACT response [12-14]. However, the majority of these studies classified IHC subtypes according to HRs and HER2 only, and they did not include the Ki-67 index; HR-positive, HER2-negative cases were generally classified as LA.…”

Section: Discussionmentioning

confidence: 99%

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Expression of Immunohistochemical Markers before and after Neoadjuvant Chemotherapy in Breast Carcinoma, and Their Use as Predictors of Response

Lee

Seol³

et al. 2013

J Breast Cancer

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PurposeFor patients with breast carcinoma, immunohistochemical markers are important factors in determining the breast cancer subtype and for establishing a therapeutic plan, including the use of neoadjuvant chemotherapy (NACT). However, it is not clear whether the expression of certain markers changes after NACT.MethodsWe assessed estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, p53, and Bcl-2 expression in specimens from 345 breast cancer cases before and after NACT. We analyzed the association between response to NACT and the expression of the markers in pre-NACT specimens. We also compared the expression between pre- and post-NACT specimens.ResultsER and PR expression was negatively associated with pathological complete response (pCR). HER2 was associated with pCR in all cases, but the association was lost when the cases were subdivided according to hormone receptor status. The pre-NACT tumor size of cases with pCR after NACT was smaller than that of cases with residual disease. HER2-enriched and triple-negative breast cancers were more likely to achieve pCR than luminal A type cancers. PR expression and the Ki-67 index decreased after NACT. A decrease in the Ki-67 index was also demonstrated in hormone receptor positive and HER2-enriched subtypes, but no similar tendency was observed in the triple-negative subtype.ConclusionA patient with breast cancer scheduled for NACT should be assessed for the breast cancer subtype, as this will influence the treatment plans for the patient. The expression of PR and Ki-67 after NACT should be interpreted carefully because NACT tends to reduce the expression of these molecules.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Expression of Immunohistochemical Markers before and after Neoadjuvant Chemotherapy in Breast Carcinoma, and Their Use as Predictors of Response

Lee

Seol³

et al. 2013

J Breast Cancer

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“…Survival is significantly prolonged in patients who achieve pCR after NAC compared to those who do not (13,14). This finding may, therefore, be used as a suitable surrogate endpoint for response in studies on NAC.…”

Section: Discussionmentioning

confidence: 99%

Survivin, Ki-67 and tumor grade as predictors of response to docetaxel-based neoadjuvant chemotherapy in locally advanced breast cancer

Liu

Chen

et al. 2013

Molecular and Clinical Oncology

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The response rates to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer (LABC) may vary and the risks may outweigh the benefits in poorly selected patients. This study investigated whether survivin expression, high-level Ki-67 expression, estrogen-receptor (ER) tumor status and high tumor grade are able to predict response to docetaxel-based NAC in LABC patients, in order to perform breast-conserving surgery. In this study, 68 patients (IIb-IIIb) completed 4–6 cycles of TAC (75 mg/m2 docetaxel, 60 mg/m2 pirarubicin and 500 mg/m2 cyclophosphamide, administered every 3 weeks). Tumor samples were obtained prior to chemotherapy. The response to chemotherapy was quantified clinically and pathologically and the histological and molecular tumor characteristics were determined. Association with response was assessed for all the parameters and the patients underwent breast-conserving surgery or radical mastectomy accordingly. A clinical complete response was observed in 21 (31%) and a partial response in 37 (54%) of the 68 patients. Thus, the overall clinical response rate (ORR) was 85%. A pathological complete response (pCR) was observed in 14 (20%) of the 68 patients and 37 patients (54%) underwent breast-conserving surgery. In the univariate analysis, survivin expression, high-level Ki-67 expression and high tumor grade (grade III) were significantly associated with ORR (P=0.007, 0.024 and 0.047, respectively). Survivin expression and high-level Ki-67 expression were significantly associated with pCR (P=0.029 and 0.048, respectively). In the multivariate analysis, survivin expression (P=0.030) and tumor grade (P=0.036), but not high-level Ki-67 and ER expression, were significantly associated with ORR and none of these factors was significantly associated with pCR. In conclusion, expression of survivin and high tumor grade were of predictive value for ORR to docetaxel-based NAC in LABC patients, leading to more patients successfully undergoing breast conserving-surgery. Immunohistochemistry of survivin and the Elston and Ellis criteria of tumor grade may provide a widely applicable, cost-effective method of patient selection for NAC.

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“…A study to assess the molecular subtypes determined by hormone receptors (Hr), Her2 status and the role of proliferation as measured by the Ki-67 marker as predictive and prognostic factors in breast cancer treatment treated with NAC (anthracycline and taxanes) with or without trastuzumab according to Her2 status showed that the PCr rate was 9% in Hr+/Her2-, 23% in Hr+/Her2+, 50% in Hr-/Her2+ and 56% in Hr-/Her2-. The PCr rate was also significantly higher in patients that had high Ki-67 of ≥20% [12] .…”

mentioning

confidence: 87%

The role of neoadjuvant chemotherapy in the surgical management of women with breast cancer in a middle-income country

et al. 2017

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Neoadjuvant chemotherapy (NAC) in women with large breast tumours can downsize tumours to allow for breast conservation surgery (BCs). The aim of this study is to compare the BCs rate between those who had NAC versus those who underwent surgery first and to determine the factors affecting response rate. 1,183 patients, who had surgery for breast cancer in a single institution from December 2012 to December 2015, were included in this study. 80 (6.8%) patients had NAC. Patient and tumours characteristics, and type of surgery were compared between those who had surgery first or surgery after NAC. Variables affecting the response rate were analyzed. The BCS rate between the surgery first and the NAC group were similar (34.2% versus 35%). The pathological complete response (PCr) rate, partial response rate and stable disease rate were 22.5%, 65% and 12.5%, respectively. PCR rate was not significantly affected by subtype of breast cancer, although there was a tendency for PCr to be higher in er-negative (32.4%), Pr-negative (26.1%) Her2-positive (28.6%), Her2-overexpressing (37.5%) and TNBC (22.7%) tumours. NAC is able to downsize tumour to achieve BCs rate that is similar to those without NAC.

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The Role of Immunohistochemistry in Breast Cancer Patients Treated With Neoadjuvant Chemotherapy: An Old Tool With an Enduring Prognostic Value

Cited by 25 publications

References 31 publications

Expression of Immunohistochemical Markers before and after Neoadjuvant Chemotherapy in Breast Carcinoma, and Their Use as Predictors of Response

Expression of Immunohistochemical Markers before and after Neoadjuvant Chemotherapy in Breast Carcinoma, and Their Use as Predictors of Response

Survivin, Ki-67 and tumor grade as predictors of response to docetaxel-based neoadjuvant chemotherapy in locally advanced breast cancer

The role of neoadjuvant chemotherapy in the surgical management of women with breast cancer in a middle-income country

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