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Annals of Surgical Oncology

, Volume 22, Issue 5, pp 1441–1446 | Cite as

Pathological Complete Response in Neoadjuvant Treatment of Breast Cancer

  • Patricia CortazarEmail author
  • Charles E. GeyerJr.
Breast Oncology

Abstract

Background

There has been recent interest in using pathological complete response (pCR) as a potential surrogate endpoint for long-term outcomes in the neoadjuvant treatment of high-risk, early-stage breast cancer.

Methods

We review the clinical trials that have contributed to our understanding of the association between pCR and long-term outcomes, describe the various definitions of pCR, describe patient populations in which pCR may predict long-term benefit, and discuss the implications of pCR on drug development and accelerated approval for neoadjuvant treatment of breast cancer.

Results

Varying definitions of pCR across clinical trials conducted in heterogeneous patient populations make understanding the association of pCR with long-term outcomes challenging. The US Food and Drug Administration established the Collaborative Trials in Neoadjuvant Breast Cancer group to evaluate the potential use of pCR as a regulatory endpoint. The group demonstrated that pCR defined as no residual invasive cancer in the breast and axillary nodes with presence or absence of in situ cancer (ypT0/is ypN0 or ypT0 ypN0) provided a better association with improved outcomes compared to eradication of invasive tumor from the breast alone (ypT0/is).

Conclusion

Even though pCR was not validated as a surrogate endpoint for long-term outcomes, the promising data regarding the strong association of pCR with substantially improved outcomes in individual patients with more aggressive subtypes of breast cancer supported the opening of an accelerated approval pathway for patients with high-risk, early-stage breast cancer.

Keywords

Overall Survival Trastuzumab Lapatinib Pertuzumab Locally Advanced Breast Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

The authors have no conflicts of interest pertaining to this publication.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  1. 1.Office of Hematology and Oncology Products, Center for Drug Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringUSA
  2. 2.Massey Cancer CenterVirginia Commonwealth UniversityVAUSA

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