Breast Cancer Research and Treatment

, Volume 109, Issue 2, pp 337–342

Assessment of clinical response after two cycles of primary chemotherapy in breast cancer

Clinical Trial

Abstract

Background Complete clinical (cCR) and pathological (pCR) response to neoadjuvant chemotherapy in breast cancer is associated with improved survival. Various imaging and immunological techniques have been tested as predictors of response early in the course of chemotherapy, but their predictive value has not been compared with that of a simple early clinical assessment. Patients and methods Two hundred breast cancer patients (T2-4, N0-1) were treated with neoadjuvant chemotherapy. Clinical response after two cycles of treatment was compared with final clinical and pathological response. The likelihood of achieving cCR or pCR was compared by response after two cycles. Results Overall final clinical response rate was 79% (30.5% cCR and 11.9% pCR). After two cycles of chemotherapy, clinical response rate was 54.5%. For responders after two cycles, final cCR = 51.3% and pCR = 21.5%. For non-responders after two cycles, cCR = 5.5% and pCR = 1.2%. Response after two cycles predicts for pCR (P = 0.003; sensitivity 95.2%, specificity 52.9%). Conclusions Clinical response after two cycles of chemotherapy predicts for pCR and is a valid early endpoint that could be incorporated into the design of future neoadjuvant trials.

Keywords

Breast cancer Clinical assessment Neoadjuvant chemotherapy Response prediction 

References

  1. 1.
    Hortobagyi GN, Ames FC, Buzdar AU et al (1988) Management of stage III primary breast cancer with primary chemotherapy, surgery and radiation therapy. Cancer 62:2507–2516PubMedCrossRefGoogle Scholar
  2. 2.
    Hortobagyi G, Buzdar A (1997) Locally advanced breast cancer. In: Bonadonna G, Hortobagyi G, Gianni A (eds) Textbook of breast cancer: a clinical guide to therapy. Martin Dunitz Ltd, Edition London, pp 155–168Google Scholar
  3. 3.
    Fisher B, Bryant J, Wolmark N, Mamounas E et al (1998) Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 16:2672–2685PubMedGoogle Scholar
  4. 4.
    Bonadonna G, Valagussa P, Brambilla C et al (1998) Primary chemotherapy in operable breast cancer: eight-year experience at the Milan Cancer Institute. J Clin Oncol 16:93–100PubMedGoogle Scholar
  5. 5.
    Makris A, Powles TJ, Ashley SE et al (1998) A reduction in the requirements for mastectomy in a randomized trial of neoadjuvant chemoendocrine therapy in primary breast cancer. Ann Oncol 9:1179–1184PubMedCrossRefGoogle Scholar
  6. 6.
    Mauriac L, MacGrogan G, Avril A et al (1999) Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up. Institut Bergonie Bordeaux Groupe Sein (IBBGS). Ann Oncol 10:47–52PubMedCrossRefGoogle Scholar
  7. 7.
    Mauri D, Pavlidis N, Ioannidis JPA (2005) Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst 97:188–194PubMedCrossRefGoogle Scholar
  8. 8.
    Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B (2001) Preoperative chemotherapy in patients with operable breast cancer: nine-year results from national surgical adjuvant breast and bowel project. J Natl Cancer Inst Monogr 30:96–102PubMedGoogle Scholar
  9. 9.
    van der Hage JA, van de Velde CJ, Julien JP et al (2001) Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol 19:4224–4237PubMedGoogle Scholar
  10. 10.
    Powles T, Hickish T, Makris A et al (1995) Randomised trial of chemoendocrine therapy started before or after surgery for treatment of primary breast cancer. J Clin Oncol 13:547–552PubMedGoogle Scholar
  11. 11.
    Ellis P, Smith I, Ashley S et al (1998) Clinical prognostic and predictive factors for primary chemotherapy in operable breast cancer. J Clin Oncol 16:107–114PubMedGoogle Scholar
  12. 12.
    Machiavelli MR, Romaro AR, Perez JE et al (1998) Prognostic significance of pathological response of primary tumour and metastatic axillary lymph nodes after neoadjuvant chemotherapy for locally advanced breast carcinoma. Cancer J Sci Am 4:125–131PubMedGoogle Scholar
  13. 13.
    Cleator SJ, Makris A, Ashley SE et al (2005) Good clinical response of breast cancers to neoadjuvant chemoendocrine therapy is associated with improved overall survival. Ann Oncol 16:267–272PubMedCrossRefGoogle Scholar
  14. 14.
    Burcombe R, Wilson G, Richman P et al (2001) Comparison of clinical, radiological and pathological assessment of response to neoadjuvant chemotherapy for primary breast cancer, vol. 37. In: European Cancer Conference, Lisbon,:p s181Google Scholar
  15. 15.
    Moskovic EC, Mansi JL, King DM et al (1993) Mammography in the assessment of response to medical treatment of large primary breast cancer. Clin Radiol 47:339–344PubMedCrossRefGoogle Scholar
  16. 16.
    Cocconi G, Di Blasio B, Alberti G et al (1984) Problems in evaluating response of primary breast cancer to systemic therapy. Breast Cancer Res Treat 4:309–313PubMedCrossRefGoogle Scholar
  17. 17.
    Jones RL, Lakhani SR, Ring AE et al (2006) Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma. Br J Cancer 94:358–362PubMedCrossRefGoogle Scholar
  18. 18.
    von Minckwitz G, Costa SD, Raab G et al (2001) Dose-dense doxorubicin, docetaxel, and granulocyte colony-stimulating factor support with or without tamoxifen as preoperative therapy in patients with operable carcinoma of the breast: a randomized, controlled, open phase IIb study. J Clin Oncol 19:3506–3515Google Scholar
  19. 19.
    Jackisch C, von Minckwitz G, Eidtmann H et al (2002) Dose-dense biweekly doxorubicin/docetaxel versus sequential neoadjuvant chemotherapy with doxorubicin/cyclophosphamide/docetaxel in operable breast cancer: second interim analysis. Clin Breast Cancer 3:276–280PubMedCrossRefGoogle Scholar
  20. 20.
    von Minckwitz G, Blohmer JU, Raab G et al (2005) In vivo chemosensitivity-adapted preoperative chemotherapy in patients with early-stage breast cancer: the GEPARTRIO pilot study. Ann Oncol 16:56–63CrossRefGoogle Scholar
  21. 21.
    Chang J, Powles TJ, Allred DC et al (1999) Biologic markers as predictors of clinical outcome from systemic therapy for primary operable breast cancer. J Clin Oncol 17:3058–3063PubMedGoogle Scholar
  22. 22.
    Ah-See ML, Makris A, Taylor NJ et al (2004) Does vascular imaging with MRI predict response to neoadjuvant chemotherapy in primary breast cancer? American Society of Clinical Oncology, New OrleansGoogle Scholar
  23. 23.
    Smith IC, Welch AE, Hutcheon AW et al (2000) Positron emission tomography using [(18)F]-fluorodeoxy-d-glucose to predict the pathologic response of breast cancer to primary chemotherapy. J Clin Oncol 18:1676–1688PubMedGoogle Scholar
  24. 24.
    Beresford M, Lyburn I, Sanghera B et al (2007) Serial integrated 18F-fluorodeoxythymidine PET/CT monitoring neoadjuvant chemotherapeutic response in invasive ductal carcinoma. Breast 13(4):425–426CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Mark J. Beresford
    • 1
    • 2
  • David Stott
    • 1
    • 3
  • Andreas Makris
    • 1
  1. 1.Mount Vernon Cancer CentreNorthwood, MiddlesexUK
  2. 2.Clinical OncologyBristol Oncology CentreBristolUK
  3. 3.Health Research Development and Support Unit (HRDSU)University of HertfordshireHatfieldUK

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