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Pathological complete response to neoadjuvant systemic therapy in 789 early and locally advanced breast cancer patients: The Royal Marsden experience

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Abstract

Purpose

Pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) for breast cancer predicts the risk of recurrence and increasingly may indicate the need for additional therapy postoperatively.

Methods

We identified non-metastatic breast cancer patients receiving NACT during 2013–2017. Patients’ and disease characteristics, rates of pCR (ypT0-is ypN0), toxicities, dose delays and reductions, and survival outcomes were recorded.

Results

789 patients had median age of 50 years. 67.8% had stage II disease, 71.1% had grade 3 , and 91.8% had ductal histopathology. 32.8% had estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, 25.5% had triple-negative (TN), and 38.0% HER2-positive disease. 6.8% received platinum. 48.2% of the HER2-positive patients received trastuzumab and pertuzumab and 51.8% received trastuzumab. Overall pCR rate was 33.5% and differed according to disease subtype, receptor status, grade, histology, and early discontinuation, but not according to age, dose reductions/delays, or year of treatment. The addition of pertuzumab to trastuzumab marginally improved the pCR rates. Survival outcomes were better following pCR.

Conclusions

In our analysis, pCR rates are consistent with the published data. Even with contemporary therapies, many patients have residual disease following NACT, suggesting a significant risk of recurrence, and may benefit from additional postoperative systemic therapy.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors wish to acknowledge the support of The Royal Marsden NIHR Biomedical Research Centre for Cancer.

Funding

The authors have no funding to report.

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Authors and Affiliations

  1. Department of Medicine – Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK

    Nicolò Matteo Luca Battisti, Victoria True, Narda Chaabouni, Sophie McGrath, Mark Allen & Alistair Ring

  2. Department of Medicine – Breast Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Rd, Chelsea, London, SW3 6JJ, UK

    Neha Chopra, Karla Lee, Scott Shepherd, Tal Shapira-Rotenberg, Rashi Joshi, Alicia Okines, Marina Parton, Nicholas Turner & Stephen Johnston

  3. Research and Development Department, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK

    Kabir Mohammed

Authors
  1. Nicolò Matteo Luca Battisti
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  2. Victoria True
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  8. Rashi Joshi
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Contributions

NMLB and AR conceived and designed the analysis. NMLB, VT, NaC, NeC, KL, SS, TSR, RJ collected the data. NMLB and KM performed the analysis. NMLB, AR, VT, NaC, NeC, KL, SS, TSR, RJ, NT, SM, MP, KM, MA, and SJ wrote the paper.

Corresponding author

Correspondence to Alistair Ring.

Ethics declarations

Conflict of interest

Dr Battisti has received travel grants from Genomic Health and Pfizer and speaker fees from Pfizer. Dr Ring has received advisory board fees from Roche, Novartis, Pfizer, and Lilly; and speaker fees from Novartis and Pfizer. Prof Johnston has received consulting and advisory board fees from Eli Lilly, AstraZeneca, Puma Biotechnology Pfizer, and Novartis; and speaker fees from Pfizer, Novartis, and Eisai; and research funding from Pfizer and Puma Biotechnology. Prof Turner has received research funding from Merck Sharp & Dohme, Pfizer, AstraZeneca, Clovis, Roches, Tesaro, and Novartis. Dr Okines has received research funding from Pfizer and speaker fees from Roche. Dr McGrath has received travel grants from Genomic Health. Dr Parton, Dr Allen, Dr True, Dr Chaabouni, Dr Chopra, Dr Lee, Dr Shepherd, Dr Shapira-Rotenberg, Dr Joshi, and Mr Mohammed have no conflict of interest.

Ethical approval

This analysis was approved as a Service Evaluation by The Committee for Clinical Review of The Royal Marsden NHS Foundation Trust.

Informed consent

No individual person’s data are included in the manuscript in any form and therefore no consents for publication were required.

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Battisti, N.M.L., True, V., Chaabouni, N. et al. Pathological complete response to neoadjuvant systemic therapy in 789 early and locally advanced breast cancer patients: The Royal Marsden experience. Breast Cancer Res Treat 179, 101–111 (2020). https://doi.org/10.1007/s10549-019-05444-0

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  • DOI: https://doi.org/10.1007/s10549-019-05444-0

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