Clinical and pathological factors predictive of response to neoadjuvant chemotherapy in breast cancer: A single center experience

Del Prete,Salvatore; Caraglia,Michele; Luce,Amalia; Montella,Liliana; Galizia,Gennaro; Sperlongano,Pasquale; Cennamo,Gregorio; Lieto,Eva; Capasso,Elena; Fiorentino,Olga; Aliberti,Maria; Auricchio,Annamaria; Iodice,Patrizia; Addeo,Raffaele

doi:10.3892/ol.2019.10729

Clinical and pathological factors predictive of response to neoadjuvant chemotherapy in breast cancer: A single center experience

Authors:
- Salvatore Del Prete
- Michele Caraglia
- Amalia Luce
- Liliana Montella
- Gennaro Galizia
- Pasquale Sperlongano
- Gregorio Cennamo
- Eva Lieto
- Elena Capasso
- Olga Fiorentino
- Maria Aliberti
- Annamaria Auricchio
- Patrizia Iodice
- Raffaele Addeo
View Affiliations

Affiliations: Division of Medical Oncology, ‘San Giovanni Di Dio Hospital’, ASL NA2NORD, I‑80027 Naples, Italy, Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, I‑80138 Naples, Italy, Division of Gastrointestinal Tract Surgical Oncology, Department of Translational Medical Sciences, University of Campania ‘L. Vanvitelli’, I‑80138 Naples, Italy, Pathologist Department, Medicina Futura Group, I‑80011 Naples, Italy
Published online on: August 7, 2019 https://doi.org/10.3892/ol.2019.10729
Pages: 3873-3879

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Neoadjuvant chemotherapy (NAC) of breast cancer (BC) improves outcomes, especially in patients with locally advanced and inflammatory cancer. Further insight into clinic‑pathological factors influencing outcomes is essential to define the optimal therapeutic strategy for each category of patients and to predict the response to the treatment. In total, 117 patients with BC were treated with NAC with or without trastuzumab between 2010 and 2015. The histologic response to NAC was defined as a pathological complete response (pCR) when there was no evidence of residual invasive tumor in the breast or axillary lymph nodes. Relapse‑free survival (RFS) was estimated using the Kaplan‑Meier method and compared using log rank analysis. P‑value <0.05 was considered statistically significant. The median age of the 117 patients enrolled in the present study was 52 years (age range, 35‑85 years). The overall response rate (complete and partial responses) assessed by radiological and pathological evaluation were 76 and 72%, respectively. pCR was achieved in 35 out of 117 patients (~30%). In total, 6 patients (5%) developed progressive disease during chemotherapy. The RFS was 85 months (SE=3; 95% CI 79‑91). The median was not reached and the mean follow‑up time was 55 months (median 52 months; range 11‑100 months). In this time, 20 patients (17%) experienced tumor recurrence. From the univariate analysis, the pathological response was significantly associated with receptor‑based subtype, menopausal status and T‑stage. From the multivariate analysis by using linear multiple regression and including receptor‑menopausal status and T‑stage, the model was not significant (P=0.062). However, by using the multiple logistic regression, and including age, pCR was significantly associated with ER+ HER2neg (P=0.006), T2 (P=0.043) and T3 (P=0.018). T‑stage, menopausal status and receptor status are significantly associated with the pathological response in patients with inoperable BC treated with NAC.

View Figures

View References

1	Thompson AM and Moulder-Thompson SL: Neoadjuvant treatment of breast cancer. Ann Oncol. 23 (Suppl 10):x231–x236. 2012. View Article : Google Scholar : PubMed/NCBI
2	Waks AG and Winer EP: Breast cancer treatment: A review. JAMA. 321:288–300. 2019. View Article : Google Scholar : PubMed/NCBI
3	Untch M, Konecny GE, Paepke S and von Minckwitz G: Current and future role of neoadjuvant therapy for breast cancer. Breast. 23:526–537. 2014. View Article : Google Scholar : PubMed/NCBI
4	Rubovszky G and Horváth Z: Recent advances in the neoadjuvant treatment of breast cancer. J Breast Cancer. 20:119–131. 2017. View Article : Google Scholar : PubMed/NCBI
5	Chen Y, Shi XE, Tian JH, Yang XJ, Wang YF and Yang KH: Survival benefit of neoadjuvant chemotherapy for resectable breast cancer: A meta-analysis. Medicine (Baltimore). 97:e106342018. View Article : Google Scholar : PubMed/NCBI
6	Early Breast Cancer Trialists' Collaborative Group (EBCTCG), . Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: Meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 19:27–39. 2018. View Article : Google Scholar : PubMed/NCBI
7	Kaufmann M, Hortobagyi GN, Goldhirsch A, Scholl S, Makris A, Valagussa P, Blohmer JU, Eiermann W, Jackesz R, Jonat W, et al: Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: An update. J Clin Oncol. 24:1940–1949. 2006. View Article : Google Scholar : PubMed/NCBI
8	Yang L, Zhong X, Pu T, Qiu Y, Ye F and Bu H: Clinical significance and prognostic value of receptor conversion in hormone receptor positive breast cancers after neoadjuvant chemotherapy. World J Surg Oncol. 16:512018. View Article : Google Scholar : PubMed/NCBI
9	Yoshida A, Hayashi N, Suzuki K, Takimoto M, Nakamura S and Yamauchi H: Change in HER2 status after neoadjuvant chemotherapy and the prognostic impact in patients with primary breast cancer. J Surg Oncol. 116:1021–1028. 2017. View Article : Google Scholar : PubMed/NCBI
10	Straver ME, Rutgers EJ, Rodenhuis S, Linn SC, Loo CE, Wesseling J, Russell NS, Oldenburg HS, Antonini N and Vrancken Peeters MT: The relevance of breast cancer subtypes in the outcome of neoadjuvant chemotherapy. Ann Surg Oncol. 17:2411–2418. 2010. View Article : Google Scholar : PubMed/NCBI
11	Curigliano G, Burstein HJ, P Winer E, Gnant M, Dubsky P, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, et al: De-escalating and escalating treatments for early-stage breast cancer: The St. Gallen International expert consensus conference on the primary therapy of early breast cancer 2017. Ann Oncol. 28:1700–1712. 2017. View Article : Google Scholar : PubMed/NCBI
12	Debiasi M, Polanczyk CA, Ziegelmann P, Barrios C, Cao H, Dignam JJ, Goss P, Bychkovsky B, Finkelstein DM, Guindalini RS, et al: Efficacy of anti-HER2 agents in combination with adjuvant or neoadjuvant chemotherapy for early and locally advanced HER2-positive breast cancer patients: A network meta-analysis. Front Oncol. 8:1562018. View Article : Google Scholar : PubMed/NCBI
13	Swain SM, Ewer MS, Viale G, Delaloge S, Ferrero JM, Verrill M, Colomer R, Vieira C, Werner TL, Douthwaite H, et al: Pertuzumab, trastuzumab, and standard anthracycline- and taxane-based chemotherapy for the neoadjuvant treatment of patients with HER2-positive localized breast cancer (BERENICE): A phase II, open-label, multicenter, multinational cardiac safety study. Ann Oncol. 29:646–653. 2018. View Article : Google Scholar : PubMed/NCBI
14	Gleeson JP, Keegan NM and Morris PG: Adding pertuzumab to trastuzumab and taxanes in HER2 positive breast cancer. Expert Opin Biol Ther. 18:251–262. 2018. View Article : Google Scholar : PubMed/NCBI
15	Nami B, Maadi H and Wang Z: Mechanisms underlying the action and synergism of trastuzumab and pertuzumab in targeting HER2-positive breast cancer. Cancers (Basel). 10(pii): E3422018. View Article : Google Scholar : PubMed/NCBI
16	Chang JC, Wooten EC, Tsimelzon A, Hilsenbeck SG, Gutierrez MC, Elledge R, Mohsin S, Osborne CK, Chamness GC, Allred DC and O'Connell P: Gene expression profiling for the prediction of therapeutic response to docetaxel in patients with breast cancer. Lancet. 362:362–369. 2003. View Article : Google Scholar : PubMed/NCBI
17	Burcombe RJ, Makris A, Richman PI, Daley FM, Noble S, Pittam M, Wright D, Allen SA, Dove J and Wilson GD: Evaluation of ER, PgR, HER-2 and Ki-67 as predictors of response to neoadjuvant anthracycline chemotherapy for operable breast cancer. Br J Cancer. 92:147–155. 2005. View Article : Google Scholar : PubMed/NCBI
18	Liu YL, Connolly EP and Kalinsky K: Obesity's impact on survival is independent of dose adjustments in neoadjuvant chemotherapy in women with breast cancer. Breast Cancer Res Treat. 168:2852018. View Article : Google Scholar : PubMed/NCBI
19	Liu YL, Saraf A, Catanese B, Lee SM, Zhang Y, Connolly EP and Kalinsky K: Obesity and survival in the neoadjuvant breast cancer setting: Role of tumor subtype in an ethnically diverse population. Breast Cancer Res Treat. 167:277–288. 2018. View Article : Google Scholar : PubMed/NCBI
20	Karatas F, Erdem GU, Sahin S, Aytekin A, Yuce D, Sever AR, Babacan T, Ates O, Ozisik Y and Altundag K: Obesity is an independent prognostic factor of decreased pathological complete response to neoadjuvant chemotherapy in breast cancer patients. Breast. 32:237–244. 2017. View Article : Google Scholar : PubMed/NCBI
21	Fontanella C, Lederer B, Gade S, Vanoppen M, Blohmer JU, Costa SD, Denkert C, Eidtmann H, Gerber B, Hanusch C, et al: Impact of body mass index on neoadjuvant treatment outcome: A pooled analysis of eight prospective neoadjuvant breast cancer trials. Breast Cancer Res Treat. 150:127–139. 2015. View Article : Google Scholar : PubMed/NCBI