Pathologic Complete Response to Preoperative Systemic Therapy in Triple Negative Breast Cancer

  • 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
  • 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
    • Patients with hormone receptor positive, HER2 negative tumors:
      • Experienced pCR:
        • In only 7.5% of cases
    • While the greatest rate of pCR:
      • Was seen in those with HER2 positive tumors:
        • Receiving anti-HER2 therapy:
          • pCR of 50%
    • Pathologic complete response:
      • Occurred in 34% women:
        • With triple negative cancers
  • Unfortunately:
    • The achievement of pCR in locally advanced TNBC:
      • Is not a reliable predictor:
        • Of better overall survival
  • 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
    • 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%)
    • Further, the authors found no significant difference:
      • In LRR, distant metastasis, overall recurrence, disease-free survival, or overall survival
  • 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
  • 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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