Abstract
Purpose
Although achieving a pathological complete response (pCR) after neoadjuvant chemotherapy
(NACT) in breast cancer predicts a better outcome, some patients still relapse. The
objectives of this study were to describe the types of events in this group of patients
and to identify predictive factors for relapse.
Methods
Patients with large operable or locally advanced breast cancers (T4d tumours were
excluded) were randomised to receive either six cycles of anthracycline-based chemotherapy
or three cycles of docetaxel followed by three cycles of eprirubicin/docetaxel. pCR
was defined as no evidence of residual invasive cancer (or very few scattered tumour
cells) in the primary tumour and axillary lymph nodes at surgery. Two Cox regression
analyses were performed to identify predictive factors of relapse: one for recurrence-free
interval (RFI) and one for distant recurrence-free interval (DRFI).
Results
Out of 283 eligible patients who achieved a pCR, 40 (14.1%) and 28 (9.9%) presented
an event of interest for the RFI and DRFI analyses, respectively. Five-year RFI, DRFI
and overall survival (OS) were 85.3% (95% confidence interval (CI), 80.1–89.3), 89.6%
(95% CI, 85.0–92.9) and 91.9% (95% CI, 87.2–94.9), respectively. No predictors for
RFI after pCR were identified. For DRFI, tumour size was the only predictor: Hazard
ratio (HR) T3 versus T1–2 = 3.62 (95% CI, 1.66–7.89); HR T4 versus T1–2: HR, 2.80 (95% CI, 0.62–12.64) p= 0.0048.
Conclusion
In this study, clinical tumour size emerged as the only predictor for DRFI after pCR,
with T3 and T4 tumours having an increased risk for distant recurrence compared to
T1–2 tumours.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis.Lancet. 2014; 384: 164-172
- TP53 status for prediction of sensitivity to taxane versus non-taxane neoadjuvant chemotherapy in breast cancer (EORTC 10994/BIG 1–00): a randomised phase 3 trial.Lancet Oncol. 2011; 12: 527-539
- A simple p53 functional assay for screening cell lines, blood, and tumors.Proc Natl Acad Sci U S A. 1995; 92: 3963-3967
- Strategies for subtypes–dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011.Ann Oncol. 2011; 22: 1736-1747
- Proposal for standardized definitions for efficacy end points in adjuvant breast cancer trials: the STEEP system.J Clin Oncol. 2007; 25: 2127-2132
- Factors predictive of distant metastases in patients with breast cancer who have a pathologic complete response after neoadjuvant chemotherapy.J Clin Oncol. 2005; 23: 7098-7104
- Predictors of recurrence in breast cancer patients with a pathologic complete response after neoadjuvant chemotherapy.Br J Cancer. 2010; 103: 297-302
- Patient and tumor characteristics associated with breast cancer recurrence after complete pathological response to neoadjuvant chemotherapy.Breast Cancer Res Treat. 2013; 137: 195-201
- Response-guided neoadjuvant chemotherapy for breast cancer.J Clin Oncol. 2013; 31: 3623-3630
Article info
Publication history
Published online: January 08, 2015
Accepted:
November 25,
2014
Received in revised form:
November 17,
2014
Received:
July 3,
2014
Identification
Copyright
© 2014 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
