- Pathologic complete response to preoperative systemic therapy:
- Is associated with a favorable:
- Disease-free survival:
- Particularly in situations in which all treatment:
- Is given preoperatively
- Particularly in situations in which all treatment:
- Disease-free survival:
- Is associated with a favorable:
- The collaborative Trials in Neoadjuvant Breast Cancer (CTNeoBC) group:
- Reviewed 12 international trials:
- With 11,955 patients:
- To evaluate the rates of pCR among patients receiving neoadjuvant chemotherapy:
- According to their tumor subtype
- To evaluate the rates of pCR among patients receiving neoadjuvant chemotherapy:
- With 11,955 patients:
- Patients with hormone receptor positive, HER2 negative tumors:
- Experienced pCR:
- In only 7.5% of cases
- Experienced pCR:
- While the greatest rate of pCR:
- Was seen in those with HER2 positive tumors:
- Receiving anti-HER2 therapy:
- pCR of 50%
- Receiving anti-HER2 therapy:
- Was seen in those with HER2 positive tumors:
- Pathologic complete response:
- Occurred in 34% women:
- With triple negative cancers
- Occurred in 34% women:
- Reviewed 12 international trials:
- Unfortunately:
- The achievement of pCR in locally advanced TNBC:
- Is not a reliable predictor:
- Of better overall survival
- Is not a reliable predictor:
- The achievement of pCR in locally advanced TNBC:
- The triple negative phenotype:
- Is more likely to be associated with BRCA1 mutations and therefore:
- Current NCCN guidelines recommend:
- Genetic testing:
- For women younger than 60 who have triple negative breast cancer
- Genetic testing:
- Current NCCN guidelines recommend:
- There are no compelling data at present:
- That the triple negative phenotype precludes breast-conserving therapy:
- In fact, one recent study:
- Found the 5-year rate of locoregional recurrence (LRR) to be similar:
- Among those having:
- Breast conserving surgery (4.2%) and
- Mastectomy (5.4%)
- Among those having:
- Found the 5-year rate of locoregional recurrence (LRR) to be similar:
- In fact, one recent study:
- That the triple negative phenotype precludes breast-conserving therapy:
- Further, the authors found no significant difference:
- In LRR, distant metastasis, overall recurrence, disease-free survival, or overall survival
- Is more likely to be associated with BRCA1 mutations and therefore:
- The accuracy of clinical examinations, mammogram, ultrasound, and MRI:
- Can be used to predict the presence of disease on final pathology:
- But none are able to reliably predict a pCR
- Can be used to predict the presence of disease on final pathology:
- References:
- von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30(15):1796-1804.
- Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164-172.
- Liedtke C, Mazouni C, Hess KR, et al. Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol. 2008;26(8):1275-1281.
- Symmans WF, Peintinger F, Hatzis C, et al. Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol. 2007;25(28):4414-4422.
- Zumsteg ZS, Morrow M, Arnold B, et al. Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1-2N0 triple-negative breast cancer. Ann Surg Oncol. 2013;20(11):3469-3476.
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Rodrigo Arrangoiz MS, MD, FACS, FSSO 