Clinical Trial

Breast Cancer Research and Treatment

, 128:127

First online:

Genomic predictors of response to doxorubicin versus docetaxel in primary breast cancer

  • M. MartinAffiliated withServicio de Oncología Médica, Hospital Universitario Gregorio Marañón, Universidad Complutense Email author 
  • , A. RomeroAffiliated withHospital Clinico San Carlos
  • , M. C. U. CheangAffiliated withLineberger Comprehensive Cancer Center, University of North Carolina
  • , J. A. López García-AsenjoAffiliated withHospital Clinico San Carlos
  • , J. A. García-SaenzAffiliated withHospital Clinico San Carlos
  • , B. OlivaAffiliated withInstituto Carlos III
  • , J. M. RománAffiliated withHospital Clinico San Carlos
  • , X. HeAffiliated withLineberger Comprehensive Cancer Center, University of North Carolina
  • , A. CasadoAffiliated withHospital Clinico San Carlos
    • , J. de la TorreAffiliated withHospital Clinico San Carlos
    • , V. FurioAffiliated withHospital Clinico San Carlos
    • , J. PuenteAffiliated withHospital Clinico San Carlos
    • , T. CaldésAffiliated withHospital Clinico San Carlos
    • , J. A. VidartAffiliated withHospital Clinico San Carlos
    • , Sara Lopez-TarruellaAffiliated withServicio de Oncología Médica, Hospital Universitario Gregorio Marañón, Universidad ComplutenseHospital Clinico San Carlos
    • , E. Diaz-RubioAffiliated withHospital Clinico San Carlos
    • , C. M. PerouAffiliated withLineberger Comprehensive Cancer Center, University of North Carolina

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Abstract

Taxanes and anthracyclines improve the outcome of early breast cancer, although the benefit is limited to a small proportion of patients and are toxic. We prospectively looked for predictors of response to these drugs. Experimental design: Four cycles of doxorubicin (75 mg/m2) or docetaxel (100 mg/m2) were compared as presurgical chemotherapy for breast cancer. Biomarkers were determined by immunohistochemistry and fluorescent in situ hybridization using prechemotherapy core biopsies. Tumors were also classified into one of the molecular intrinsic subtypes using an immunohistochemical panel of five biomarkers and genomic profiles. Single genes and intrinsic subtypes were correlated with response to doxorubicin versus docetaxel. Among the 204 evaluable patients, significant predictors of sensitivity in multivariate analysis were low topo2a expression and ER-negative status for doxorubicin and small tumor size and ER-negative status for docetaxel. Predictors of resistance in multivariate analysis were triple-negative status (ER/PgR/HER2 negative by IHC/FISH) for doxorubicin, and high TNM stage for docetaxel. Triple-negative tumors were associated with topo2a overexpression more than the other subtypes. In 94 patients with gene expression profiles, docetaxel was superior to doxorubicin in the basal-like subtype (good pathological response rate − PCR + class I of 56 vs. 0%; P = 0.034); no significant differences were observed in the other subtypes when comparing these two drugs. Low topo2a expression and ER-negative status were predictors of response to doxorubicin, while small tumor size and ER-negative status predicted response to docetaxel. Docetaxel was superior to doxorubicin in triple-negative/basal-like tumors, while no significant differences were seen in the remaining intrinsic subtypes.

Keywords

Breast cancer Doxorubicin Docetaxel Genomic subtypes