Breast Cancer Research and Treatment

, Volume 124, Issue 1, pp 133–140 | Cite as

Effect of neoadjuvant anthracycline–taxane-based chemotherapy in different biological breast cancer phenotypes: overall results from the GeparTrio study

  • Jens Huober
  • Gunter von Minckwitz
  • Carsten Denkert
  • Hans Tesch
  • Erich Weiss
  • Dirk Michael Zahm
  • Antje Belau
  • Fariba Khandan
  • Maik Hauschild
  • Christoph Thomssen
  • Bernhard Högel
  • Silvia Darb-Esfahani
  • Keyur Mehta
  • Sibylle LoiblEmail author
Clinical trial


In order to explore the effect of neoadjuvant chemotherapy (NACT) on clinical mid-course and pathological complete response (pCR) at surgery in different biological breast cancer subtypes. The GeparTrio study included 2,072 patients with operable or locally advanced breast cancer. After two cycles with docetaxel, doxorubicin and cyclophosphamide (TAC) patients were randomized according to their clinical response. Clinical and biological factors were assessed for predicting clinically mid-course response and pCR at surgery. The overall pCR rate, defined as no invasive residuals in breast and axilla, was 20.5%. The highest pCR rate of 57% was observed in patients below 40 years of age with triple negative or grade 3 tumors. Independent factors for mid-course response and pCR were: young age, non-T4 tumors, high grade, and hormone receptor status, the strongest single predictive factor. Within the biological subtypes, grading was an independent factor to predict pCR for luminal tumors, clinical tumor stage for the HER2 like tumors and age for the triple negative ones. Grading gave independent information for mid-course response within the triple negative group. No factor predicted mid-course response within the other groups. Grading and age can identify subgroups within the luminal and triple negative patients who have an increased benefit from NACT.


Neoadjuvant chemotherapy Breast cancer Predictive factors Lobular histology Age 

Supplementary material

10549_2010_1103_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 22 kb)


  1. 1.
    Darb-Esfahani S, Loibl S, Müller BM et al (2009) Identification of biology-based breast cancer types with distinct predictive and prognostic features: role of steroid hormone and HER2 receptor expression in patients treated with neoadjuvant anthracycline/taxane-based chemotherapy. Breast Cancer Res 11:R69CrossRefPubMedGoogle Scholar
  2. 2.
    von Minckwitz G, Sinn HP, Raab G et al (2008) Clinical response after two cycles compared to HER2, Ki-67, p53, and bcl-2 in independently predicting a pathological complete response after preoperative chemotherapy in patients with operable carcinoma of the breast. Breast Cancer Res 10(2):R30CrossRefGoogle Scholar
  3. 3.
    Rouzier R, Perou CM, Symmans WF et al (2005) Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res 11:5678–5685CrossRefPubMedGoogle Scholar
  4. 4.
    Colleoni M, Viale G, Zahrieh D et al (2008) Expression of ER, PgR, HER1, HER2 and response: a study of preoperative chemotherapy. Ann Oncol 19:465–472CrossRefPubMedGoogle Scholar
  5. 5.
    Colleoni M, Bagnardi V, Rotmensz N et al (2009) Increasing steroid hormone receptors expression defines breast cancer subtypes non responsive to preoperative chemotherapy. Breast Cancer Res Treat 116:359–369CrossRefPubMedGoogle Scholar
  6. 6.
    von Minckwitz G, Raab G, Caputo A et al (2005) Doxorubicin with cyclophosphamide followed by docetaxel every 21 days compared with doxorubicin and docetaxel every 14 days as preoperative treatment in operable breast cancer: the Geparduo study of the German Breast Group. J Clin Oncol 23:2676–2685CrossRefGoogle Scholar
  7. 7.
    von Minckwitz G, Kuemmel S, Vogel P et al (2008) Intensified neoadjuvant chemotherapy in early-responding breast cancer: phase III randomized GeparTrio study. J Natl Cancer Inst 100:552–562CrossRefGoogle Scholar
  8. 8.
    von Minckwitz G, Kümmel S, Vogel P et al (2008) Neoadjuvant vinorelbine–capecitabine versus docetaxel–doxorubicin–cyclophosphamide in early nonresponsive breast cancer: a phase III randomized GeparTrio trial. J Natl Cancer Inst 100:542–551CrossRefGoogle Scholar
  9. 9.
    Sinn HP, Schmid H, Junkermann H et al (1994) Histological regression of breast cancer after primary (neoadjuvant) chemotherapy. Geburtsh u Frauenheilk 54:552–558CrossRefGoogle Scholar
  10. 10.
    Loibl S, Müller B, Roller M et al. (2008) Local versus central HER2 immunohistochemistry correlates with kinetic RT-PCR but only central immunohistochemistry and RT-PCR predict pathological complete response: results from the neoadjuvant multicenter Gepar-Trio trial. Cancer Res 69(Suppl) (2): Abstract 1070Google Scholar
  11. 11.
    Guarneri V, Broglio K, Kau S-W et al (2006) Prognostic value of pathological complete response after primary chemotherapy in relation to hormone receptor status and other factors. J Clin Oncol 24:1037–1044CrossRefPubMedGoogle Scholar
  12. 12.
    Sorlie T, Perou CM, Tibshirani R et al (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 98:10869–10874CrossRefPubMedGoogle Scholar
  13. 13.
    Liedtke C, Hatzis C, Symmans FW et al (2009) Genomic Grade Index is associated with response to chemotherapy in patients with breast cancer. J Clin Oncol 27:3185–3191CrossRefPubMedGoogle Scholar
  14. 14.
    von Minckwitz G, Budczies J, Loibl S et al. (2009) Validated 3 gene signature predicts response to neo-adjuvant chemotherapy in luminal breast cancer—results from GeparTrio and GeparQuattro study. Cancer Res 69(Suppl) (24): Abstract 2132Google Scholar
  15. 15.
    Mazoumi C, Peintinger F, Wan-Kau S et al (2007) Residual carcinoma in situ in patients with complete eradication of invasive breast cancer after neoadjuvant chemotherapy does not adversely affect patient outcome. J Clin Oncol 25:2650–2655CrossRefGoogle Scholar
  16. 16.
    Goldstein NS, Decker D, Severson D et al (2007) Molecular classification system identifies invasive breast carcinoma patients who are most likely and those who are least likely to achieve a complete pathologic response after neoadjuvant chemotherapy. Cancer 110:1687–1696CrossRefPubMedGoogle Scholar
  17. 17.
    Rakha EA, Ellis IO (2009) Triple-negative/basal-like breast cancer: review. Pathology 41:40–47CrossRefPubMedGoogle Scholar
  18. 18.
    Liedtke C, Mazouni C, Hess KR et al (2008) Response to neoadjuvant chemotherapy and long term-survival in patients with triple negative breast cancer. J Clin Oncol 26:1275–1281CrossRefPubMedGoogle Scholar
  19. 19.
    Cristofanilli M, Gonzalez-Angulo A, Sneige N et al (2005) Invasive lobular carcinoma classic type: response to primary chemotherapy and survival outcomes. J Clin Oncol 23:41–48CrossRefPubMedGoogle Scholar
  20. 20.
    Katz A, Saad EA, Porter P et al (2007) Primary systemic chemotherapy of invasive lobular carcinoma of the breast. Lancet Oncol 8:55–62CrossRefPubMedGoogle Scholar
  21. 21.
    Pestalozzi BC, Zahrieh D, Mallon E et al (2008) Distinct clinical and prognostic features of infiltrating lobular carcinoma of the breast: combined results of 15 International Breast Cancer Study Group clinical trials. J Clin Oncol 18:3006–3014CrossRefGoogle Scholar
  22. 22.
    Bonnefoi H, Potti A, Delorenzi M et al (2007) Validation of gene signatures that predict the response of breast cancer to neoadjuvant chemotherapy: a substudy of the EORTC 10994/BIG 00-01 clinical trial. Lancet Oncol 8:1071–1078CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Jens Huober
    • 1
    • 2
  • Gunter von Minckwitz
    • 3
  • Carsten Denkert
    • 4
  • Hans Tesch
    • 5
  • Erich Weiss
    • 6
  • Dirk Michael Zahm
    • 7
  • Antje Belau
    • 8
  • Fariba Khandan
    • 9
  • Maik Hauschild
    • 10
  • Christoph Thomssen
    • 11
  • Bernhard Högel
    • 12
  • Silvia Darb-Esfahani
    • 4
  • Keyur Mehta
    • 3
  • Sibylle Loibl
    • 3
    Email author
  1. 1.Brustzentrum Kantonsspital St. GallenSt. GallenSwitzerland
  2. 2.Department of GynaecologyUniversity TübingenTübingenGermany
  3. 3.German Breast GroupNeu-IsenburgGermany
  4. 4.Charité, Institute of Pathology, Translational Tumorpathology UnitBerlinGermany
  5. 5.Onkologische Gemeinschaftspraxis am Bethanien KrankenhausFrankfurt am MainGermany
  6. 6.Hospital Sindelfingen-BöblingenBöblingenGermany
  7. 7.SRH WaldklinikenGeraGermany
  8. 8.Department of GynaecologyUniversity GreifswaldGreifswaldGermany
  9. 9.St. Markus HospitalFrankfurt am MainGermany
  10. 10.Hospital RheinfeldenRheinfeldenGermany
  11. 11.Department of GynaecologyMartin Luther UniversityHalleGermany
  12. 12.Frauenklinik vom Roten KreuzMünchenGermany

Personalised recommendations