Impact of progression during neoadjuvant chemotherapy on surgical management of breast cancer.
Caudle Abigail S,Gonzalez-Angulo Ana M,Hunt Kelly K,Pusztai Lajos,Kuerer Henry M,Mittendorf Elizabeth A,Hortobagyi Gabriel N,Meric-Bernstam Funda
Annals of surgical oncology
BACKGROUND:Although neoadjuvant chemotherapy (NCT) is standard therapy for locally advanced breast cancer, it remains controversial for early-stage disease due to concerns that disease progression may make breast-conservation therapy (BCT), or even operability, impossible. The goal of this study was to determine the impact of disease progression during NCT on surgical management. METHODS:We reviewed clinicopathological data on patients who received NCT for stage I-III breast cancer from 1994 to 2007. Chemotherapy regimens were anthracycline-and/or taxane-based as determined by the treating medical oncologist. RESULTS:Of 1,928 patients who received NCT, 1,762 (91%) had a partial or complete response, 107 (6%) had stable disease (SD), and 59 (3%) progressed (PD) while receiving at least one regimen. Of the patients with progressive disease, 40 (68%) patients underwent mastectomy, 12 (20%) underwent BCT, and 7 (12%) did not undergo surgery. In patients who underwent mastectomy, only three (8%) were BCT candidates before progression. Overall, disease progression changed the operative plan in 11 (0.5%) patients: 3 developed distant metastasis, 2 developed clinical lymphadenopathy, 3 required mastectomy instead of BCT, 2 became inoperable, and 1 required flap closure. CONCLUSIONS:Disease progression while receiving NCT is infrequent (3%), but early identification may allow for change to other, potentially beneficial, therapeutic interventions. Patients with breast cancer who receive NCT should be evaluated frequently for response to therapy. Overall, progression during NCT changes the surgical management in a small proportion of patients.
A single-institution experience of salvage therapy for patients with early and locally advanced breast cancer who progress during neoadjuvant chemotherapy.
Raphael Jacques,Paramsothy Thivaher,Li Nim,Lee Justin,Gandhi Sonal
Breast cancer research and treatment
PURPOSE:Progression during neoadjuvant chemotherapy (NAT) for early and locally advanced breast cancer is generally uncommon. However, these patients tend to do poorly, and salvage therapy (ST) use is variable and often not well defined. We aimed to establish the characteristics and outcomes of breast cancer (BC) patients progressing on NAT, report the patterns of institutional ST usage, and identify predictors of ST failure. METHODS:A retrospective review was conducted using the "Biomatrix" institutional database. Fisher's exact test was used to study the association between baseline characteristics and progression after ST. Survival outcomes were estimated using Kaplan-Meier. Disease-Free Survival 1 (DFS1) and DFS2 represent the time between diagnosis and first progression, and the first and second progression, respectively. The log-rank test was used to compare survival outcomes between different ST types. RESULTS:Thirty patients out of 413 (7.2%) progressed on primary NAT, with a median follow-up of 28.52 months (13.77-46.97) and a mean age of 57 years (standard deviation: 12). The two most frequently used ST modalities were surgery (43%) and radiation with concurrent cisplatin chemotherapy (CT/RT) (40%). Eighty percent of the patients made it to subsequent surgery and among those, 11 (69%) were initially not operable and their tumors were rendered surgically removable after ST. The initial tumor stage and grade, and the presence of lymphovascular invasion predicted progression after ST (p = 0.02, p = 0.03 and p = 0.01, respectively). Median DFS1, DFS2, and overall survival were 4.4 months (95% CI 3.6-5.7), 14.8 months (95% CI 2.37-NR), and 39.5 months (95% CI 22.73-NR), respectively. No difference in survival outcomes based on ST type was seen. CONCLUSION:In this evaluated cohort and despite potential poorer outcomes, patients progressing on NAT responded well to ST, became operable, and had promising survival outcomes. Appropriate selection of ST is crucial, and can help improve outcomes in such patients.
The treatment option of progressive disease in breast cancer during neoadjuvant chemotherapy: a single-center experience.
Zheng Yurong,Ding Xiaowen,Zou Dehong,Zhang Fanrong,Qin Chengdong,Yang Hongjian,Mo Wenju,Ding Yuqin,Yu Yang
Cancer biology & therapy
Patients' responses to breast cancer neoadjuvant chemotherapy (NACT) differ because of heterogeneous tumor characteristics. Reports about NACT progression are sporadic. Here we enrolled 1187 patients who received NACT in our cancer center between January 1, 2007, and December 31, 2016. We analyzed the characteristics and treatments of patients with progressive disease (PD) or non-PD or pathological complete response (pCR). In total, 45 (3.8%) patients had PD. PD patients were associated with a significantly worse disease-free survival (DFS) (hazard ratio (HR) = 3.77; 95% CI, 1.77 to 8.00; =.001) and overall survival (OS) (HR = 3.85; 95% CI, 1.77 to 8.35; =.001). For the PD patients, 28 (62.2%) patients received mastectomy immediately after PD, and 17 (37.8%) changed to chemotherapy. DFS and OS exhibited no significant differences between these two salvage therapies. After a change to second chemotherapy, 58.8% (10/17) patients had PD or SD. With the exception of tumor size, pretreatment T stage, and histology type, no other significant differences were noted between PD and pCR patients. Our results demonstrated that PD patients were associated with a significantly worse prognosis. Based on these results, we suggest to give the addition of trastuzumab to HER-2 positive patients instead of changing the chemotherapy regimen and proceeding to surgery instead of further chemotherapy once patients have PD during NACT. Given that some similar characteristics exist between PD and pCR patients, more studies to identify novel molecular markers to predict disease response to NACT should be performed.