Can a pathological-Complete Response to systemic neo-adjuvant chemotherapy be predicted & does it predict outcomes in symptomatic breast cancer?
Association of Breast Surgery ePoster Library. Rowland M. 05/15/17; 166187; P113
Mr. Matthew Philip Rowland
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Abstract
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Introduction:
Systemic Neo-Adjuvant Chemotherapy (NAC) is increasingly used in symptomatic disease. There remains variation in opinion on who should undergo NAC and for which indications. We aimed to assess who achieves a pathological-Complete Response (pCR) & if this influences long-term outcomes
Methods:
Retrospective cohort of all our breast cancer patients undergoing systemic NAC between 2010 -2015; Clinical notes and oncology letters were reviewed until last follow-up or death. Chi-Squared and Student-T-test statistics were used
Results:
74 patients underwent NAC followed by surgery; mean age 48years. 65/74 had IDCs often Grade-III (52/74). Phenotypically 21/74 tumours were HER2+ and 15/74 were Triple-negative, the remainder (38/74) Luminal A/B. 4/74 had NAC aborted but went onto surgery, none died. 25/74 had a pCR in the breast and 15/50 a pCR in axilla; 3/50 had a dual pCR. Mean Ki67% was not different between those achieving pCR, 62% vs. 52% (p0.16). HER2+ and Triple-Negative tumours were more likely to achieve pCR in the breast (48% & 40%), HER2+ tumours achieving the highest rates of pCR in the Axilla (48%). HER2+ tumours with pCR tend towards lower recurrence rates (p.07) and Triple-Negative phenotype may experience higher loco-regional recurrence. In those who relapse the mean time to relapse does not appear to be influenced by the pCR.
Conclusions:
Tumour phenotype can help predict the likelihood of pCR but Ki67% does not. HER2+ tumours with pCR may have lower recurrence, although the time to recurrence seems unaffected. Triple-negative tumours may experience more loco-regional recurrence even with multi-modal therapy.
Systemic Neo-Adjuvant Chemotherapy (NAC) is increasingly used in symptomatic disease. There remains variation in opinion on who should undergo NAC and for which indications. We aimed to assess who achieves a pathological-Complete Response (pCR) & if this influences long-term outcomes
Methods:
Retrospective cohort of all our breast cancer patients undergoing systemic NAC between 2010 -2015; Clinical notes and oncology letters were reviewed until last follow-up or death. Chi-Squared and Student-T-test statistics were used
Results:
74 patients underwent NAC followed by surgery; mean age 48years. 65/74 had IDCs often Grade-III (52/74). Phenotypically 21/74 tumours were HER2+ and 15/74 were Triple-negative, the remainder (38/74) Luminal A/B. 4/74 had NAC aborted but went onto surgery, none died. 25/74 had a pCR in the breast and 15/50 a pCR in axilla; 3/50 had a dual pCR. Mean Ki67% was not different between those achieving pCR, 62% vs. 52% (p0.16). HER2+ and Triple-Negative tumours were more likely to achieve pCR in the breast (48% & 40%), HER2+ tumours achieving the highest rates of pCR in the Axilla (48%). HER2+ tumours with pCR tend towards lower recurrence rates (p.07) and Triple-Negative phenotype may experience higher loco-regional recurrence. In those who relapse the mean time to relapse does not appear to be influenced by the pCR.
Conclusions:
Tumour phenotype can help predict the likelihood of pCR but Ki67% does not. HER2+ tumours with pCR may have lower recurrence, although the time to recurrence seems unaffected. Triple-negative tumours may experience more loco-regional recurrence even with multi-modal therapy.
Introduction:
Systemic Neo-Adjuvant Chemotherapy (NAC) is increasingly used in symptomatic disease. There remains variation in opinion on who should undergo NAC and for which indications. We aimed to assess who achieves a pathological-Complete Response (pCR) & if this influences long-term outcomes
Methods:
Retrospective cohort of all our breast cancer patients undergoing systemic NAC between 2010 -2015; Clinical notes and oncology letters were reviewed until last follow-up or death. Chi-Squared and Student-T-test statistics were used
Results:
74 patients underwent NAC followed by surgery; mean age 48years. 65/74 had IDCs often Grade-III (52/74). Phenotypically 21/74 tumours were HER2+ and 15/74 were Triple-negative, the remainder (38/74) Luminal A/B. 4/74 had NAC aborted but went onto surgery, none died. 25/74 had a pCR in the breast and 15/50 a pCR in axilla; 3/50 had a dual pCR. Mean Ki67% was not different between those achieving pCR, 62% vs. 52% (p0.16). HER2+ and Triple-Negative tumours were more likely to achieve pCR in the breast (48% & 40%), HER2+ tumours achieving the highest rates of pCR in the Axilla (48%). HER2+ tumours with pCR tend towards lower recurrence rates (p.07) and Triple-Negative phenotype may experience higher loco-regional recurrence. In those who relapse the mean time to relapse does not appear to be influenced by the pCR.
Conclusions:
Tumour phenotype can help predict the likelihood of pCR but Ki67% does not. HER2+ tumours with pCR may have lower recurrence, although the time to recurrence seems unaffected. Triple-negative tumours may experience more loco-regional recurrence even with multi-modal therapy.
Systemic Neo-Adjuvant Chemotherapy (NAC) is increasingly used in symptomatic disease. There remains variation in opinion on who should undergo NAC and for which indications. We aimed to assess who achieves a pathological-Complete Response (pCR) & if this influences long-term outcomes
Methods:
Retrospective cohort of all our breast cancer patients undergoing systemic NAC between 2010 -2015; Clinical notes and oncology letters were reviewed until last follow-up or death. Chi-Squared and Student-T-test statistics were used
Results:
74 patients underwent NAC followed by surgery; mean age 48years. 65/74 had IDCs often Grade-III (52/74). Phenotypically 21/74 tumours were HER2+ and 15/74 were Triple-negative, the remainder (38/74) Luminal A/B. 4/74 had NAC aborted but went onto surgery, none died. 25/74 had a pCR in the breast and 15/50 a pCR in axilla; 3/50 had a dual pCR. Mean Ki67% was not different between those achieving pCR, 62% vs. 52% (p0.16). HER2+ and Triple-Negative tumours were more likely to achieve pCR in the breast (48% & 40%), HER2+ tumours achieving the highest rates of pCR in the Axilla (48%). HER2+ tumours with pCR tend towards lower recurrence rates (p.07) and Triple-Negative phenotype may experience higher loco-regional recurrence. In those who relapse the mean time to relapse does not appear to be influenced by the pCR.
Conclusions:
Tumour phenotype can help predict the likelihood of pCR but Ki67% does not. HER2+ tumours with pCR may have lower recurrence, although the time to recurrence seems unaffected. Triple-negative tumours may experience more loco-regional recurrence even with multi-modal therapy.
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