QuoteReplyTopic: Pathologic Complete Response (pCR) on Prognosis Posted: Jan 18 2019 at 11:17am
MikeW,
The discussion is about the initial diagnosis and for women who have neoadjuvant chemo prior to surgery. I'm assuming it would be women initially diagnosed with Stage 0 - 3 breast cancer. I guess it could include Stage 4 too if the neoadjuvant therapy shows a complete response at the time of surgery.
"Pathologic complete response after neoadjuvant
chemotherapy was associated with a significantly lower recurrence risk
and higher overall survival in patients with breast cancer, and
pathologic complete response after neoadjuvant chemotherapy had a
similar association with improved outcomes among those who received
adjuvant chemotherapy vs those who did not, according to meta-analyses
of data from 52 clinical trials presented by Spring et al at the 2018
San Antonio Breast Cancer Symposium (Abstract GS2-03).
A pathologic complete response was defined as the
lack of all signs of invasive cancer in the breast tissue and lymph
nodes removed during surgery after treatment with chemotherapy."
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09) 11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15
Interesting but what stage were they talking about? My wife is Stage 4 TNBC but recently had 2, 3 month apart, clear PET scans. She got NED on Halaven, after Xeloda and AC failed her.
SABCS 2018: Meta-analysis of Pathologic Complete Response and Outcomes in Breast Cancer
Overall, patients with breast cancer who had a pathologic complete response were 69% less likely to have a disease recurrence compared with those who did not have a pathologic complete response. The relationship was strongest among patients with triple-negative or HER2-positive breast cancer with a pathologic complete response, where such patients were 82% and 68% less likely, respectively, to have disease recurrence.
Key Points
Patients with breast cancer who had a pathologic complete response were 69% less likely to have disease recurrence compared with those who did not have a pathologic complete response. The relationship was strongest among patients with triple-negative or HER2-positive breast cancer with a pathologic complete response, where such patients were 82% and 68% less likely, respectively, to have a disease recurrence.
Patients with a pathologic complete response also had a 78% lower risk for mortality compared with those who did not have pathologic complete response overall.
The association of pathologic complete response with reduced recurrence was comparable between patients who received adjuvant chemotherapy (66% less likely to have recurrence) and those who did not receive adjuvant chemotherapy (64% less likely to have recurrence).
Axillary pathologic complete response linked to longer survival in breast cancer
Axillary pathologic complete response appeared associated with improved 10-year RFS and OS in patients with breast cancer who had cytologically confirmed axillary lymph node metastases, according to the results of a retrospective study.
". . .They retrospectively reviewed medical records of women diagnosed with stage II to stage III breast cancer with axillary lymph node metastases. All study participants received primary systemic chemotherapy between 1987 and 2007 at MD Anderson Cancer Center.
Researchers stratified women by axillary status after primary systemic chemotherapy and estimated survival outcomes according to response in the breast and axilla.
OS and RFS served as primary endpoints.
The analysis included data from 1,600 women (median age at diagnosis, 49 years; range, 21-86), of whom 454 (28.4%) achieved axillary pathologic complete response.
Women who achieved axillary pathologic complete response appeared more likely to have HER-2–positive or triple-negative breast cancer (P < .001), pathologic complete response in the breast (P < .001), high-grade tumors (P < .001), and lower clinical and pathologic T stage (P = .002).
Compared with patients who had residual axillary disease, patients with axillary pathologic complete response appeared more likely to achieve 10-year OS (84% vs. 57%; P < .001) and RFS (79% vs. 50%; P < .001).
Among patients with axillary pathologic complete response, 10-year OS was higher among those with pathologic complete response in the breast (90% vs. 72%; P < .001).
Among patients with residual axillary disease, those who achieved pathologic complete response in the breast achieved better 10-year OS (66% vs. 56%; P = .02). . . "
Holmes said the CTNeoBC meta-analysis2 showed that achieving pCR following preoperative chemotherapy was an especially strong predictor of event-free survival in aggressive forms of breast cancer. Attaining pCR reduced the risk of death by 92% in cancers that were HER2-positive and hormone receptor–negative cancers and by 84% in triple-negative breast cancers (TNBCs). - See more at: http://www.onclive.com/publications/Oncology-live/2014/November-2014/Expert-Says-pCR-Data-Support-Neoadjuvant-Therapy-in-HER2-Positive-Breast-Cancer#sthash.DZsgo6EU.dpuf
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09) 11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15
Smaller study on Prognostic Factors for 3N Patients Receiving Preoperative Systemic Therapy from 2013.
Edited by mindy555 - Sep 03 2014 at 8:00pm
Dx July 2011 56 yo Stage I IDC,TN,Grade 3 Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia Daughter also BRCA1+ Mass grew on Taxol FEC 6x better BMX 3/19/12 pCR NED BSO 6/2012
This is precisely what my MO was trying to explain to me. Having seen the aggressiveness of some stage I tumors, we ultimately came to the conclusion biology trumps all. However, according to my onc. size plays a highly significant role.
My own post BMX path was held up due to possible in situ cells. The end conclusion was there were none and pathology was clear. I'm hoping this is the case and they didn't lose the specimen. I too hope node status is studied more in-depth.
Thanks for posting Donna and hope you're doing well Deb.
Dx July 2011 56 yo Stage I IDC,TN,Grade 3 Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia Daughter also BRCA1+ Mass grew on Taxol FEC 6x better BMX 3/19/12 pCR NED BSO 6/2012
Thanks for posting this. I read this several days ago and was very happy to read the conclusion that size does matter. Everything up to this point has been black and white; complete response or not, good prognosis or not, and no grey area. It is nice to know that some shade of grey does exist. I do hope that they also go back and analyze the data with the node status to see if that makes any differnce.
Is seems like there has been some encouraging news this past week!
Deb
One final note: currently there is no treatment consequence to belonging to one subtype over another, except for LumA's generally not needing chemotherapy.
Luminal A, Luminal B, Basal, ERBB2, and Normal subtypes are all classifications of breast cancer derived from gene expression studies. They are called 'intrinsic subtypes', and are similar but not identical to subtyping using receptors like ER and PGR and HER2 by IHC or FISH. Luminal A cancers tend to be ER positive (estrogen receptor), HER2 negative, and with a low proliferation (Ki67) rate. Luminal B cancers are usually ER positive as well, but can also have positive HER2 status and are likely to have higher proliferation. They are the more aggressive subset of ER+ cancers. Most TNs are Basal, though some are distributed among the other subtypes.
Donna - what does luminal A and luminal B mean? I see it must be a sub-type but does anyone ever get tested for these subtypes? How would we know if we have this subtype? I have never heard the term luminal A or B before.
Found lump 9/16/11, age 55, Diagnosed 10/27 IDC TN, LX/SNB 12/7/11, Stage 1, Grade 3, 1.8 cm, 0/3 nodes, BRCA-, DD A/C on 1/23/12, followed by DD Taxol. 3/14/14 Stage IV, 3/26/14 Paclitaxel
Definition and Impact of Pathologic Complete Response on Prognosis After Neoadjuvant Chemotherapy in Various Intrinsic Breast
Cancer Subtypes
Purpose The exact definition of pathologic complete response (pCR) and its prognostic impact on survival in intrinsic breast cancer
subtypes is uncertain.
Methods Tumor response at surgery and its association with long-term outcome of 6,377 patients with primary breast cancer receiving
neoadjuvant anthracycline-taxane–based chemotherapy in seven randomized trials were analyzed.
Results Disease-free
survival (DFS) was significantly superior in patients with no invasive
and no in situ residuals in breast or
nodes (n = 955) compared with patients with
residual ductal carcinoma in situ only (n = 309), no invasive residuals
in breast
but involved nodes (n = 186), only
focal-invasive disease in the breast (n = 478), and gross invasive
residual disease (n
= 4,449; P < .001). Hazard ratios
for DFS comparing patients with or without pCR were lowest when defined
as no invasive and no in situ
residuals (0.446) and increased monotonously
when in situ residuals (0.523), no invasive breast residuals but
involved nodes
(0.623), and focal-invasive disease (0.727) were
included in the definition. pCR was associated with improved DFS in
luminal
B/human epidermal growth factor receptor 2
(HER2) –positive (P = .013), HER2-positive/nonluminal (P < .001), and triple-negative (P < .001) tumors but not in luminal A (P = .39) or luminal B/HER2-positive (P = .45) breast cancer. pCR in HER2-positive (nonluminal) and triple-negative tumors was associated with excellent prognosis.
Conclusion pCR defined
as no invasive and no in situ residuals in breast and nodes can best
discriminate between patients with favorable
and unfavorable outcomes. Patients with
noninvasive or focal-invasive residues or involved lymph nodes should
not be considered
as having achieved pCR. pCR is a suitable
surrogate end point for patients with luminal B/HER2-negative,
HER2-positive (nonluminal),
and triple-negative disease but not for those
with luminal B/HER2-positive or luminal A tumors.
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