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Objectives: To evaluate the rate of pathologic complete response (pCR) in patients with breast carcinoma who received neoadjuvant chemotherapy.
Methodology: The following cross sectional study was conducted at the Department of Oncology, Hayatabad medical complex from December 2022 to May 2023 comprising of 174 patients aged between 30-70 years. Keeping inclusion and exclusion criteria in perspective sampling was done through non-probability consecutive sampling technique. The primary outcome measured was the complete pathological response (pCR), which was assessed based on four categories: stage and lymph node, molecular signature, chemotherapy regimen, and age. Data analysis was achieved using SPSS version 23.0 and results were depicted in the form of description, tables and graphs.
Results: Out of 174 patients, 27 patients achieved a pathologic complete response (pCR). Among the patients classified based on stage and lymph node involvement, the highest number (n= 25, 31.6%) of pCR cases was observed in the stage II lymph node-negative group. The study also analyzed pCR rates based on the molecular signature. The triple-negative subtype exhibited the top pCR rate of 26 %. Furthermore, the study assessed pCR rates based on different chemotherapy regimens. The maximum pCR rate was observed in patients receiving TCHP (20%). Among the patients based on age, those aged less than 35 years had the highest pCR rate (100%).
Conclusion: The propensity of neo-adjuvant chemotherapy (NACT) to convert an in-operable tumor into an operable one is unprecedented. This allows conservative surgery to take place with reduced morbidity and mortality among cancer patients.
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DeSantis CE, Ma J, Gaudet MM, Newman LA, Miller KD, Sauer GA, et al. Breast cancer statistics, 2019. CA: Cancer J Clin. 2019;69(6):438-51. DOI: 10.3322/caac.21583.
Rehman B, Mumtaz A, Sajjad B, Urooj N, Khan SM, Zahid MT, et al. Papillary Carcinoma of Breast: Clinicopathological Characteristics, Management, and Survival. Int J Breast Cancer. 2022; 5427837. DOI: 10.1155/2022/5427837.
Lukasiewicz S, Czeczelewski M, Forma A, Baj J, Sitarz R, Stanislawek A. Breast cancer - epidemiology, risk factors, classification, prognostic markers, and current treatment strategies - an updated review. Cancers. 2021;13(17):4287. DOI: 10.3390/cancers13174287.
Hyder T, Bhattacharya S, Gade K, Nasrazadani A, Brufsky AM. Approaching neoadjuvant therapy in the management of early-stage breast cancer. Targets Ther. 2021;199-211. DOI: 10.2147/BCTT.S273058.
Ortmann O, Blohmer JU, Sibert NT, Brucker S, Janni W, Wockel A, et al. Current clinical practice and outcome of neoadjuvant chemotherapy for early breast cancer: analysis of individual data from 94,638 patients treated in 55 breast cancer centers. J Cancer Res Clin Oncol. 2023;149(3):1195-209. DOI: 10.1007/s00432-022-03938-x.
Asselain B, Barlow W, Bartlett J, Bergh J, Bergsten-Nordstrom E, Bliss J, et al. Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomized trials. Lancet Oncol. 2018;19(1):27- 39. DOI: 10.1016/S1470-2045 (17)30777-5.
Caudle AS, Yang WT, Krishnamurthy S, Mittendorf EA, Black DM, Gilcrease MZ, et al. Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection. J Clin Oncol. 2016;34(10):1072. DOI: 10.1200/JCO. 2015.64.0094.
Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164-72. DOI: 10.1016/SO140-6736(13)62422-8.
Spring LM, Fell G, Arfe A, Sharma C, Greenup R, Reynolds KL, et al. Pathologic complete response after neoadjuvant chemotherapy and impact on breast cancer recurrence and survival: a comprehensive meta-analysis. Clin Cancer Res. 2020;26(12):2838-48. DOI: 10.1158/1078-0432.CCR-19- 3492.
Riedel F, Hoffmann AS, Moderow M, Heublein S, Deutsch TM, Golatta M, et al. Time trends of neoadjuvant chemotherapy for early breast cancer. Int J Cancer. 2020;147(11):3049-58. DOI: 10.100/ijc.33122.
Inwald EC, Kowalski C, Wesselmann S, Ferencz J, Ortmann O. Recommendation of adjuvant trastuzumab treatment in HER-2-positive breast cancer patients: insights from quality indicator data collected in certified breast cancer centers in Germany, Italy, Austria, and Switzerland. Arch Gynecol Ob-stet. 2019;300:383-8. DOI: 10.1007/ s00404-019-05185-x .
Cortazar P, Geyer CE. Pathological complete response in neoadjuvant treatment of breast cancer. Ann Surg Oncol. 2015;22:1441-6. DOI: 10.1245/ s10434-015-4404-8.
Guarneri V, Broglio K, Kau SW, Cristofanilli M, Buzdar AU, Valero V, et al. Prognostic value of pathologic complete response after primary chemotherapy in relation to hormone receptor status and other factors. J Clin Oncol. 2006;24(7):1037-44. DOI: 10.1200/ JCO.2005.02.6914.
Golshan M, Cirrincione CT, Sikov WM, Carey LA, Berry DA, Overmoyer B, et al. Impact of neoadjuvant therapy on eligibility for and frequency of breast conservation in stage II–III HER2-positive breast cancer: surgical results of CALGB 40601 (Alliance). Breast Cancer Res Treat. 2016;160:297-304. DOI: 10.1007/s10549-016-4006-6
Golshan M, Loibl S, Wong SM, Huober JB, O’Shaughnessy J, Rugo HS, et al. Breast conservation after neoadjuvant chemotherapy for triple-negative breast cancer: surgical results from the Brightness randomized clinical trial. JAMA Surg. 2020;155(3):e195410. DOI: 10.1001/jamasurg.2019.5410.
Mougalian SS, Soulos PR, Killelea BK, Lannin DR, Abu Khalaf MM, DiGiovanna MP, et al. Use of neoadjuvant chemotherapy for patients with stage I to III breast cancer in the United States. Cancer. 2015;121(15):2544-52. DOI: 10.1002/cncr.29348.
Vugts G, Maaskant-Braat AJ, Nieuwenhuijzen GA, Roumen RM, Luiten EJ, Voogd AC. Patterns of care in the administration of neo-adjuvant chemotherapy for breast cancer. A population-based study. Breast J. 2016;22(3):316-21. DOI: 10.1111/tbj.12568.
Vaidya JS, Massarut S, Vaidya HJ, Alexander EC, Richards T, Caris JA, et al. Rethinking neoadjuvant chemotherapy for breast cancer. Brit Med J. 2018;360. DOI:10.1136/bmj.j5913.
Asaoka M, Narui K, Suganuma N, Chishima T, Yamada A, Sugae S, et al. Clinical and pathological predictors of recurrence in breast cancer patients achieving pathological complete response to neoadjuvant chemotherapy. Eur J Surg Oncol. 2019;45(12):2289- 94. DOI:10.1016/j.ejso2019.08.001.
Denkert C, Loibl S, Müller BM, Eidtmann H, Schmitt WD, Eiermann W, et al. Ki67 levels as predictive and prognostic parameters in pretherapeutic breast cancer core biopsies: a translational investigation in the neoadjuvant Gepar Trio trial. Ann Oncol. 2013;24(11):2786-93. DOI.10.1093/annonc/mdr350.
Ravelli A, Roviello G, Cretella D, Cavazzoni A, Biondi A, Cappelletti MR, Zanotti L, Ferrero G, Ungari M, Zanconati F, Bottini A. Tumor-infiltrating lymphocytes and breast cancer: beyond the prognostic and predictive utility. Tumor Biol. 2017;39(4). DOI: 10.1177/1010428317695023.
Schmid P, Adams S, Rugo HS, Schneeweiss A, Barrios CH, Iwata H, et al. Atezolizumab and nab-paclitaxel in advanced triple-negative breast cancer. N Engl J Med. 2018;379(22):2108-21. DOI: 10.1056/NEJMoa1809615.