Breast Cancer

, Volume 19, Issue 4, pp 282–288 | Cite as

Neoadjuvant chemotherapy in breast cancer—insights from the German experience

Conference Paper
First Online:
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Accepted:

Abstract

New insights into neoadjuvant treatment of breast cancer have shown that the prognostic value of pathological complete response has to be rated differently according to subtype. Whereas in triple-negative, HER2-positive (non-luminal) and luminal B (HER2-negative) patients with a pCR after neoadjuvant chemotherapy show a significantly better outcome than patients without a pCR, this prognostic impact cannot be seen in patients with luminal A or luminal B (HER2-positive) tumors. Patients can therefore only avoid an initially high-risk prognosis if they have a pCR of these first mentioned subtypes. For patients with those tumors or with high Ki-67 levels in residual disease, new treatment options have to be found. Contrarily, response-guided chemotherapy, i.e., changing the regimen in case of no early response or intensification in case of early response, showed significant survival advantages only in the latter group. Strategies are currently being developed on how locoregional treatment can be reduced in patients with a pathological complete response. These aim to reduce the extent of surgery or even avoid surgery completely.

Keywords

Breast cancer Neoadjuvant Chemotherapy Molecular subtypes Ki-67 Pathological complete response 
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References

  1. 1.
    von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of pathological complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30:1796–804.CrossRefGoogle Scholar
  2. 2.
    Goldhirsch A, Wood WC, Coates AS, et al. Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St.Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011;22:1736–47.PubMedCrossRefGoogle Scholar
  3. 3.
    Prowell TM, Pazdur R. Pathological complete response and accelerated drug approval in early breast cancer. NEJM. 2012;366:2438–41.PubMedCrossRefGoogle Scholar
  4. 4.
    Gianni L, Eiermann W, Semiglazov V, et al. Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet. 2010;375(9712):377–84.PubMedCrossRefGoogle Scholar
  5. 5.
    Untch M, Loibl S, Bischoff J, et al. Lapatinib versus trastuzumab in combination with neoadjuvant anthracycline–taxane-based chemotherapy (GeparQuinto, GBG 44): a randomised phase 3 trial. Lancet Oncol. 2012;13(2):135–44.PubMedCrossRefGoogle Scholar
  6. 6.
    Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol. 2012;13(1):25–32.PubMedCrossRefGoogle Scholar
  7. 7.
    O’Shaughnessy J, Osborne C, Pippen JE, et al. Iniparib plus chemotherapy in metastatic triple-negative breast cancer. N Engl J Med. 2011;364:205–14.PubMedCrossRefGoogle Scholar
  8. 8.
    O’Shaughnessy J, Schwartzberg MA, Danso HS et al. A randomized phase III study of iniparib (BSI-201) in combination with gemcitabine/carboplatin (G/C) in metastatic triple-negative breast cancer (TNBC). J Clin Oncol 2011; 29: suppl (Abstr 1007).Google Scholar
  9. 9.
    Llombard A, Lluch A, Villanueva C et al. SOLTI NeoPARP: a phase II, randomized study of two schedules of iniparib plus paclitaxel and paclitaxel alone as neoadjuvant therapy in patients with triple-negative breast cancer (TNBC). J Clin Oncol 2012; 30 (suppl; abstr 1011).Google Scholar
  10. 10.
    von Minckwitz G, Eidtmann H, Rezai M, et al. Neoadjuvant chemotherapy and bevacizumab for HER2-negative breast cancer. N Engl J Med. 2012;366(4):299–309.CrossRefGoogle Scholar
  11. 11.
    Gerber B, Eidtman H, Rezai M et al. Neoadjuvant bevacizumab and anthracycline–taxane-based chemotherapry in 686 triple-negative primary breast cancers: seconday endpoint analysis of the GeparQuinto study (GBG 44). J Clin Oncol 2011; 29: suppl (Abstr 1006).Google Scholar
  12. 12.
    Gianni L, Bianchini G, Kiermaier A, et al. Neoadjuvant pertuzumab (P) and trastuzumab (H): biomarker analyses of a 4-Arm randomized phase II study (NeoSphere) in patients (pts) with HER2-positive breast cancer (BC). Cancer Res. 2011;71(Suppl 24):Abst S5–1.Google Scholar
  13. 13.
    Huober J, Loibl S, Untch M, et al. New molecular biomarkers for resistance to trastuzumab-based in primary HER2 positive breast cancer—a translational investigation from the neoadjuvant GeparQuattro study. Cancer Res 2010;70 (Suppl 24): Abstract PD02–06.Google Scholar
  14. 14.
    Loibl S, Bruey JM, von Minckwitz G, et al. Validation of p95 as a predictive marker for trastuzumab-based therapy in primary HER2-positive breast cancer: a translational investigation from the neoadjuvant GeparQuattro study. J Clin Oncol 2011;29 (suppl): abstr 530.Google Scholar
  15. 15.
    Guarneri V et al. Preoperative chemotherapy plus trastuzumab, lapatinib, or both in human epidermal growth factor receptor 2—positive operable breast cancer: results of the randomized phase II CHER-LOB study. JCO published online on April 9, 2012. doi: 10.1200/JCO.2011.39.0823.
  16. 16.
    von Minckwitz G, Muller BM, Loibl S, et al. Cytoplasmic poly(ADP-ribose)polymerase expression is predictive and prognostic in patients with breast cancer treated with neoadjuvant chemotherapy. J Clin Oncol. 2011;29:2150–7.CrossRefGoogle Scholar
  17. 17.
    von Minckwitz G, Müller B, Blohmer JU, et al. Prognostic and predictive impact of Ki-67 before and after neoadjuvant chemotherapy on PCR and survival: Results of the GeparTrio trial. J Clin Oncol. 2012;30: (suppl; abstr 1023).Google Scholar
  18. 18.
    von Minckwitz G, Kummel S, Vogel P, et al. Intensified neoadjuvant chemotherapy in early-responding breast cancer: phase III randomized GeparTrio study. J Natl Cancer Inst. 2008;100:552–62.CrossRefGoogle Scholar
  19. 19.
    von Minckwitz G, Kümmel S, Vogel P, et al. Neoadjuvant vinorelbine-capecitabine versus docetaxel-doxorubicin-cyclophosphamide in early nonresponsive breast cancer: phase III randomized GeparTrio trial. J Natl Cancer Inst. 2008;100:542–51.CrossRefGoogle Scholar
  20. 20.
    von Minckwitz G, Blohmer JU, Costa SD, et al. Neoadjuvant chemotherapy adapted by interim response improves overall survival of primary breast cancer patients—results of the GeparTrio trial. Cancer Res. 2011;71(24 Suppl.):103s.Google Scholar
  21. 21.
    von Minckwitz G, Kaufmann M, Kümmel S, et al. Local recurrence risk after neoadjuvant chemotherapy. Pooled analysis on 5477 breast cancer patients. Cancer Res. 2011;71(24 suppl.):142s.Google Scholar

Copyright information

© The Japanese Breast Cancer Society 2012

Authors and Affiliations

  1. 1.German Breast GroupGBG Forschungs GmbHNeu-IsenburgGermany

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