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Pathologic Complete Response (pCR) on Prognosis

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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Topic: Pathologic Complete Response (pCR) on Prognosis
    Posted: May 01 2012 at 10:37am
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.

http://jco.ascopubs.org/content/early/2012/04/11/JCO.2011.38.8595.abstract



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

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Post Options Post Options   Thanks (0) Thanks(0)   Quote CatWhispurrer Quote  Post ReplyReply Direct Link To This Post Posted: May 13 2012 at 11:45am
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
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Post Options Post Options   Thanks (0) Thanks(0)   Quote dmwolf Quote  Post ReplyReply Direct Link To This Post Posted: May 14 2012 at 8:16pm
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.  

I hope that helps!
d

DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote dmwolf Quote  Post ReplyReply Direct Link To This Post Posted: May 14 2012 at 8:18pm
One final note:  currently there is no treatment consequence to belonging to one subtype over another, except for LumA's generally not needing chemotherapy.
DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Sep 25 2012 at 9:24pm

Triple-negative breast cancer (TNBC) and residual disease (non-pCR): Does size matter?


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

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Post Options Post Options   Thanks (0) Thanks(0)   Quote debB Quote  Post ReplyReply Direct Link To This Post Posted: Sep 25 2012 at 10:22pm
Donna,

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
Dx 4/29/11, 46 yrs old, 3.9 cm tumor, Stg 2 Grade 3 chemo 4 rounds DD AC, 12 weekly taxol, finish. Lumpectomy, 2mm residual tumor. 37 rounds rads completed. Cisplatin/PARP trial
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Post Options Post Options   Thanks (0) Thanks(0)   Quote mindy555 Quote  Post ReplyReply Direct Link To This Post Posted: Sep 30 2012 at 12:27am
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
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Sep 02 2014 at 11:11pm
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

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Post Options Post Options   Thanks (0) Thanks(0)   Quote mindy555 Quote  Post ReplyReply Direct Link To This Post Posted: Sep 03 2014 at 7:43pm
Here's another link to get to a PDF which squelches pCR being an independent prognosis marker- with other factors influencing TNBC outcomes.

Hope this works Wacko

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCAQFjAA&url=http%3A%2F%2Fwww.clinical-breast-cancer.com%2Farticle%2FS1526-8209%2812%2900217-0%2Fpdf&ei=hYgHVKPCKsSujALm6oDIDw&usg=AFQjCNENHxaZMmTz0hTGIvEVUTnMPzl9nw&bvm=bv.74115972,d.cGE

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
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Oct 18 2014 at 12:54pm
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

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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Oct 22 2014 at 9:40pm
http://www.onclive.com/publications/Oncology-live/2014/November-2014/Expert-Says-pCR-Data-Support-Neoadjuvant-Therapy-in-HER2-Positive-Breast-Cancer

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

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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Dec 30 2015 at 12:40pm
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 (< .001), pathologic complete response in the breast (< .001), high-grade tumors (< .001), and lower clinical and pathologic T stage (= .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%; < .001) and RFS (79% vs. 50%; < .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%; < .001).

Among patients with residual axillary disease, those who achieved pathologic complete response in the breast achieved better 10-year OS (66% vs. 56%; = .02). . . "

To read the entire article:

http://www.healio.com/hematology-oncology/breast-cancer/news/online/%7Baf25341d-0e0e-4987-90cd-dddc0980999c%7D/axillary-pathologic-complete-response-linked-to-longer-survival-in-breast-cancer

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

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