Pauline Gillon1, Nathan Touati2, Christel Breton-Callu1, Leen Slaets2, David Cameron3, Hervé Bonnefoi4. 1. Department of Radiotherapy, Institut Bergonié Unicancer, Bordeaux, France. 2. EORTC, Statistics Department, Avenue Emmanuel Mounier 83b11, 1200 Brussels, Belgium. 3. Western General Hospital, Edinburgh Cancer Centre, Crewe Road South, GB Edinburgh EH4 2XU, United Kingdom. 4. Department of Medical Oncology, Institut Bergonié Unicancer, Univ. Bordeaux, INSERM U1218, INSERM CIC1401 Bordeaux, France. Electronic address: h.bonnefoi@bordeaux.unicancer.fr.
Abstract
PURPOSE: Identification of clinicopathological factors predicting for a locoregional recurrence (LRR) after neoadjuvant chemotherapy (NAC) could help to decide on the optimal locoregional radiotherapy. The objective of this trial is to identify those factors in the context of a phase III trial (European Organisation for Research and Treatment of Cancer 10994). METHODS: Patients received NAC followed by surgery with or without radiotherapy. Radiotherapy was administered according to pre-specified guidelines. Patients with hormone receptor positive tumours received adjuvant hormonal therapy. A proportion of patients with human epidermal growth factor receptor 2 (HER2) positive cancer received adjuvant trastuzumab. The predictive factors for LRR were identified by multivariate analysis with time to LRR as first event as the primary end-point. RESULTS: The median follow-up was 4.4 years. In 1553 eligible patients, there were 76 LRRs with a 5-year cumulative incidence of 4.9% (95% confidence interval, CI [3.76-6.04]). In multivariate analysis, breast cancer subtype was a significant predictor of LRR (p < 0.0001): hazard ratio (HR) 6.44 (95% CI [2.83-14.69]) for triple negative, 6.26 (95% CI [2.81-13.93]) for HER2+ without trastuzumab (T) and 3.37 (95% CI [1.10-10.34]) for HER2+ with T cancers, all compared to luminal A patients. Lack of pathological response was also associated with significantly higher LRR risk in case of ≥4 pathologically positive nodes, HR 2.43 (95% CI [1.34-4.40], p < 0.0001). CONCLUSION: Breast cancer subtype and lack of pathological response are predictive factors for high LRR after NAC.
RCT Entities:
PURPOSE: Identification of clinicopathological factors predicting for a locoregional recurrence (LRR) after neoadjuvant chemotherapy (NAC) could help to decide on the optimal locoregional radiotherapy. The objective of this trial is to identify those factors in the context of a phase III trial (European Organisation for Research and Treatment of Cancer 10994). METHODS:Patients received NAC followed by surgery with or without radiotherapy. Radiotherapy was administered according to pre-specified guidelines. Patients with hormone receptor positive tumours received adjuvant hormonal therapy. A proportion of patients with humanepidermal growth factor receptor 2 (HER2) positive cancer received adjuvant trastuzumab. The predictive factors for LRR were identified by multivariate analysis with time to LRR as first event as the primary end-point. RESULTS: The median follow-up was 4.4 years. In 1553 eligible patients, there were 76 LRRs with a 5-year cumulative incidence of 4.9% (95% confidence interval, CI [3.76-6.04]). In multivariate analysis, breast cancer subtype was a significant predictor of LRR (p < 0.0001): hazard ratio (HR) 6.44 (95% CI [2.83-14.69]) for triple negative, 6.26 (95% CI [2.81-13.93]) for HER2+ without trastuzumab (T) and 3.37 (95% CI [1.10-10.34]) for HER2+ with T cancers, all compared to luminal A patients. Lack of pathological response was also associated with significantly higher LRR risk in case of ≥4 pathologically positive nodes, HR 2.43 (95% CI [1.34-4.40], p < 0.0001). CONCLUSION:Breast cancer subtype and lack of pathological response are predictive factors for high LRR after NAC.
Authors: David Krug; René Baumann; Wilfried Budach; Jürgen Dunst; Petra Feyer; Rainer Fietkau; Wulf Haase; Wolfgang Harms; Thomas Hehr; Marc D Piroth; Felix Sedlmayer; Rainer Souchon; Frederik Wenz; Rolf Sauer Journal: Strahlenther Onkol Date: 2018-07-04 Impact factor: 3.621
Authors: Ariane A van Loevezijn; Marieke E M van der Noordaa; Marcel P M Stokkel; Erik D van Werkhoven; Emma J Groen; Claudette E Loo; Paula H M Elkhuizen; Gabe S Sonke; Nicola S Russell; Frederieke H van Duijnhoven; Marie-Jeanne T F D Vrancken Peeters Journal: Breast Cancer Res Treat Date: 2022-03-03 Impact factor: 4.872