Neoadjuvant chemotherapy is associated with improved survival compared with adjuvant chemotherapy in patients with triple-negative breast cancer only after complete pathologic response.
ABSTRACT Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer that is known to be chemosensitive. In patients with TNBC, we sought to compare survival outcomes between patients receiving neoadjuvant chemotherapy, with and without complete pathologic response (pCR), and those receiving adjuvant chemotherapy.
We performed a retrospective chart review and identified 385 patients with stage I-III TNBC who were treated with neoadjuvant or adjuvant chemotherapy between 2000 and 2008. Patients were divided according to receipt of neoadjuvant chemotherapy with pCR, neoadjuvant chemotherapy without pCR, and adjuvant chemotherapy. Data were compared using Fisher's exact test and analysis of variance (ANOVA). Kaplan-Meier curves were generated.
Of 385 patients, 151 (39%) received neoadjuvant chemotherapy and 234 (61%) received adjuvant chemotherapy. Twenty-six (17%) of those patients receiving neoadjuvant chemotherapy had pCR. After controlling for covariates associated with survival in unadjusted tests, patients undergoing neoadjuvant chemotherapy with residual tumor had significantly worse survival compared with patients receiving adjuvant therapy [hazard ratio (HR) = 0.51, P = 0.007] and a trend towards worse survival compared with patients receiving neoadjuvant therapy with pCR (HR = 0.19, P = 0.10).
Although previous clinical trials have not demonstrated a survival difference between patients receiving neoadjuvant versus adjuvant chemotherapy for breast cancer, our study suggests an overall survival benefit in patients with pCR following neoadjuvant chemotherapy compared with patients receiving adjuvant therapy. It is clear that a prospective study needs to be carried out to better elucidate the timing of chemotherapy in patients with TNBC.
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ABSTRACT: This study is to investigate the predictive and prognostic value of ER-α36 expression in breast cancer patients treated with chemotherapy. ER-α36 expression in 120 breast cancer tumors was assessed by an immunohistochemistry assay. All patients were divided into two groups according to the chemotherapy procedure: group A, 50 patients who underwent neoadjuvant chemotherapy before surgery; group B, 70 patients who were performed adjuvant chemotherapy after surgery, and they all took at least two cycles of anthracycline-based and/or paclitaxel-based chemotherapy after surgery. The therapy effect on group A patients was evaluated two cycles later by Response Evaluation Criteria in Solid Tumors version 1.0 (RECIST 1.0). ER-α36 protein was positively expressed in 51 tumor specimens (42.5%) and no correlation was found between the expression of ER-α 36 and the expression of the full-length ER-α (ER-α66), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER-2), Ki-67, tumor sizes, and the numbers of lymph node metastasis. Patients with ER-α36 negative expression tumors treated with the neoadjuvant chemotherapy had a higher remission rate [partial response: stable: progressed (n) 25:3:1 vs 11:9:1; p=0.009], a better response (86% vs 52%; p=0.009), and a more favorable outcomes in triple-negative breast cancer patients compared to ER-α36 positive patients and ER-α36 negative expression was correlated with DFS in patients treated with neoadjuvant chemotherapy. ER-α36 negative tumors benefit more from neoadjuvant chemotherapy and have better prognosis, which may warrant further studies with larger size of the sample.Steroids 06/2014; DOI:10.1016/j.steroids.2014.03.003 · 2.72 Impact Factor
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ABSTRACT: Neoadjuvant chemotherapy (NAC) is one of the standard care regimens for patients with resectable early-stage breast cancer. It would be advantageous to determine the chemosensitivity of tumors before initiating NAC. One of the parameters potentially compromising such chemosensitivity would be a hypoxic microenvironment of cancer cells. The aim of this study was thus to clarify the correlation between expression of the hypoxic marker carbonic anhydrase-9 (CA9) and chemosensitivity to NAC as well as prognosis of breast cancer patients.BMC Cancer 06/2014; 14(1):400. DOI:10.1186/1471-2407-14-400 · 3.32 Impact Factor
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ABSTRACT: We carried out a systematic review and meta-analysis to evaluate the predictive roles of tumor infiltrating lymphocytes (TILs) in response to neoadjuvant chemotherapy (NAC) in breast cancer. A PubMed and Web of Science literature search was designed. Random or fixed effect models were adopted to estimate the summary odds ratio (OR). Heterogeneity and sensitivity analyses were performed to explore heterogeneity among studies and to assess the effects of study quality. Publication bias was evaluated using a funnel plot, Egger's test and Begg's test. We included studies where the predictive significance of TILs, and/or TILs subset on the pathologic complete response (pCR) were determined in NAC of breast cancer. A total of 13 published studies (including 3251 patients) were eligible. In pooled analysis, the detection of higher TILs numbers in pre-treatment biopsy was correlated with better pCR to NAC (OR = 3.93, 95% CI, 3.26-4.73). Moreover, TILs predicted higher pCR rates in triple negative (OR = 2.49, 95% CI: 1.61-3.83), HER2 positive (OR = 5.05, 95% CI: 2.86-8.92) breast cancer, but not in estrogen receptor (ER) positive (OR = 6.21, 95%CI: 0.86-45.15) patients. In multivariate analysis, TILs were still an independent marker for high pCR rate (OR = 1.41, 95% CI: 1.19-1.66). For TILs subset, higher levels of CD8+ and FOXP3+ T-lymphocytes in pre-treatment biopsy respectively predicted better pathological response to NAC (OR = 6.44, 95% CI: 2.52-16.46; OR = 2.94, 95% CI: 1.05-8.26). Only FOXP3+ lymphocytes in post-NAC breast tissue were a predictive marker for low pCR rate in univariate (OR = 0.41, 95% CI: 0.21-0.80) and multivariate (OR = 0.36, 95% CI: 0.13-0.95) analysis. Higher TILs levels in pre-treatment biopsy indicated higher pCR rates for NAC. TILs subset played different roles in predicting response to NAC.PLoS ONE 12/2014; 9(12):e115103. DOI:10.1371/journal.pone.0115103 · 3.53 Impact Factor