Waqar Haque1,2, Vivek Verma3, Sandra Hatch4, V Suzanne Klimberg5, E Brian Butler6, Bin S Teh6. 1. Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA. waqarh786@gmail.com. 2. Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center, and Research Institute, Weil Cornell Medical College, Houston, TX, 77030, USA. waqarh786@gmail.com. 3. Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA. 4. Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA. 5. Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA. 6. Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA.
Abstract
PURPOSE: This is the largest study to date evaluating response rates and pathologic complete response (pCR) and predictors thereof, based on molecular subtype, in women with breast cancer having undergone neoadjuvant chemotherapy (NC). METHODS: The National Cancer Database was queried for women with cT1-4N1-3M0 breast cancer having received NC. Patients were divided into four subtypes: luminal A, luminal B, Her2, or triple negative (TN). Multivariable logistic regression ascertained factors associated with developing pCR. Kaplan-Meier analysis evaluated overall survival (OS) between patients by degree of response to NC when stratifying patients by subtype. RESULTS: Of a total of 13,939 women, 322 (2%) were luminal A, 5941 (43%) luminal B, 2274 (16%) Her2, and 5402 (39%) TN. Overall, 19% of all patients achieved pCR, the lowest in luminal A (0.3%) and the highest in Her2 (38.7%). Molecular subtype was an independent predictor of both pCR and OS in this population. Clinical downstaging was associated with improved survival, mostly in women with luminal B, Her2, and TN subtypes. Subgroup analysis of the pCR population demonstrated 5-year OS in the luminal B, Her2, and TN cohorts of 93.0, 94.2, and 90.6%, respectively (Her2 vs. TN, p = 0.016). CONCLUSIONS: Assessing nearly 14,000 women from a contemporary United States database, this is the largest known study examining the relationship between response to NC and molecular subtype. Women with luminal A disease are the least likely to undergo pCR, with the highest rates in Her2 disease. Degree of response is associated with OS, especially in luminal B, Her2, and TN patients. Despite the comparatively higher likelihood of achieving pCR in TN cases, this subgroup may still experience a survival detriment, which has implications for an ongoing national randomized trial.
PURPOSE: This is the largest study to date evaluating response rates and pathologic complete response (pCR) and predictors thereof, based on molecular subtype, in women with breast cancer having undergone neoadjuvant chemotherapy (NC). METHODS: The National Cancer Database was queried for women with cT1-4N1-3M0 breast cancer having received NC. Patients were divided into four subtypes: luminal A, luminal B, Her2, or triple negative (TN). Multivariable logistic regression ascertained factors associated with developing pCR. Kaplan-Meier analysis evaluated overall survival (OS) between patients by degree of response to NC when stratifying patients by subtype. RESULTS: Of a total of 13,939 women, 322 (2%) were luminal A, 5941 (43%) luminal B, 2274 (16%) Her2, and 5402 (39%) TN. Overall, 19% of all patients achieved pCR, the lowest in luminal A (0.3%) and the highest in Her2 (38.7%). Molecular subtype was an independent predictor of both pCR and OS in this population. Clinical downstaging was associated with improved survival, mostly in women with luminal B, Her2, and TN subtypes. Subgroup analysis of the pCR population demonstrated 5-year OS in the luminal B, Her2, and TN cohorts of 93.0, 94.2, and 90.6%, respectively (Her2 vs. TN, p = 0.016). CONCLUSIONS: Assessing nearly 14,000 women from a contemporary United States database, this is the largest known study examining the relationship between response to NC and molecular subtype. Women with luminal A disease are the least likely to undergo pCR, with the highest rates in Her2 disease. Degree of response is associated with OS, especially in luminal B, Her2, and TN patients. Despite the comparatively higher likelihood of achieving pCR in TN cases, this subgroup may still experience a survival detriment, which has implications for an ongoing national randomized trial.
Authors: Eneida Turiján-Espinoza; Víctor Manuel Ruíz-Rodríguez; Edith Elena Uresti-Rivera; Ernesto Martínez-Leija; José de Jesús Zermeño-Nava; Arturo Guel-Pañola; Silvia Romano-Moreno; Juan Manuel Vargas-Morales; Diana Patricia Portales-Pérez Journal: Cancer Chemother Pharmacol Date: 2021-03-19 Impact factor: 3.333
Authors: Lisa Prior; Richard O'Dwyer; Abdul Rehman Farooq; Megan Greally; Cian Ward; Connor O'Leary; Razia Aslam; Waseem Darwish; Nada Ahmed; Elly Che Othman; Geoffrey Watson; Deirdre Kelly; Jack Gleeson; Lisa Kiely; Anees Hassan; Elaine M Walsh; David O'Reilly; Alfred Jones; Hannah Featherstone; Marvin Lim; Hazel Murray; Bryan T Hennessy; Lillian M Smyth; Gregory Leonard; Liam Grogan; Oscar Breathnach; Paula Calvert; Anne M Horgan; Linda Coate; Emmet J Jordan; Deirdre O'Mahony; Rajnish Gupta; Maccon M Keane; Jennifer Westrup; Karen Duffy; Miriam O'Connor; Patrick G Morris; M John Kennedy; Seamus O'Reilly; John McCaffrey; Catherine M Kelly; Desmond Carney; Giuseppe Gullo; John Crown; Michaela J Higgins; Paul M Walsh; Janice M Walshe Journal: Breast Cancer Res Treat Date: 2021-06-14 Impact factor: 4.872
Authors: T J Stankowski-Drengler; J R Schumacher; B Hanlon; D Livingston-Rosanoff; K Van de Walle; C C Greenberg; L G Wilke; H B Neuman Journal: Ann Surg Oncol Date: 2020-01-03 Impact factor: 5.344
Authors: Susan M Farabaugh; Beate C Litzenburger; Ashuvinee Elangovan; Geoffrey Pecar; Lauren Walheim; Jennifer M Atkinson; Adrian V Lee Journal: Dev Biol Date: 2020-05-04 Impact factor: 3.582
Authors: Yul Ri Chung; Ji Won Woo; Soomin Ahn; Eunyoung Kang; Eun-Kyu Kim; Mijung Jang; Sun Mi Kim; Se Hyun Kim; Jee Hyun Kim; So Yeon Park Journal: Sci Rep Date: 2021-06-09 Impact factor: 4.379