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ER, PgR, Ki67, p27(Kip1), and histological grade as predictors of pathological complete response in patients with HER2-positive breast cancer receiving neoadjuvant chemotherapy using taxanes followed by fluorouracil, epirubicin, and cyclophosphamide concomitant with trastuzumab.

Kurozumi S, Inoue K, Takei H, Matsumoto H, Kurosumi M, Horiguchi J, Takeyoshi I, Oyama T - BMC Cancer (2015)

Bottom Line: A high pathological complete response (pCR) rate has been achieved using this regimen; however, the predictive factors and prognostic effects of pCR currently remain unclear.RFS was significantly better in the pCR group than in the non-pCR group (p = 0.018).Patients with remaining nodal disease in the pCR group had worse OS (p = 0.0002).

View Article: PubMed Central - PubMed

Affiliation: Division of Breast Surgery, Saitama Cancer Center, Saitama, Japan. chachagot-a-mail@hotmail.co.jp.

ABSTRACT

Background: Neoadjuvant chemotherapy (NAC) with taxanes followed by fluorouracil, epirubicin, and cyclophosphamide (FEC), and concurrent trastuzumab is a potent regimen for HER2 over-expressing breast cancer. A high pathological complete response (pCR) rate has been achieved using this regimen; however, the predictive factors and prognostic effects of pCR currently remain unclear. In the present study, we determined whether pCR was related to histological grade (HG) and several biological factors including p27(Kip1). We also assessed the prognosis of the pCR and non-pCR groups, and expected differences between those positive and negative for lymph node metastasis after chemotherapy.

Methods: A total of 129 Japanese women with HER2-positive invasive breast cancer received either paclitaxel or docetaxel followed by FEC, with the concomitant administration of trastuzumab. The statuses of HG, ER, PgR, Ki67, and p27(Kip1) were evaluated to determine their relationship with pCR. Relapse-free survival (RFS) and overall survival (OS) were also analyzed for their relationship with pCR and pathological nodal involvement.

Results: pCR was obtained in 84 out of 129 patients and the pCR rate was 65.1%. The pCR rates related to 5 factors were as follows: HG (grade 3, 70.0% vs. grades 1-2, 36.8%), ER (negative, 78.6% vs. positive, 40.0%), PgR (negative, 75.3% vs. positive, 38.9%), Ki67 (high, 72.0% vs. low, 47.2%), and p27(Kip1) (low, 71.0% vs. high, 50.0%). RFS was significantly better in the pCR group than in the non-pCR group (p = 0.018). Patients with remaining nodal disease in the pCR group had worse OS (p = 0.0002).

Conclusions: High-HG, low-ER, low-PgR, high-Ki67, and low-p27(Kip1) were identified as predictive factors of pCR in NAC with trastuzumab, while pCR and negative nodes were predictive of better survivals.

No MeSH data available.


Related in: MedlinePlus

Overall survival curve of pCR patients with and without lymph node metastasis. In pCR cases, OS was significantly better in patients without lymph node metastasis than in those with lymph node metastasis (HR = 13.34, p = 0.0002)
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Fig3: Overall survival curve of pCR patients with and without lymph node metastasis. In pCR cases, OS was significantly better in patients without lymph node metastasis than in those with lymph node metastasis (HR = 13.34, p = 0.0002)

Mentions: The median RFS was 53 months (range, 3–108 months) and median follow-up duration was 59 months (range, 13–108 months). RFS was significantly better in the 84 patients with pCR after NAC with trastuzumab than in the 45 patients with non-pCR [hazard ratio (HR) = 0.40, 95 % CI = 0.15 to 0.79, p = 0.012] (Fig. 2). Of the 84 patients with pCR, OS was significantly worse in those with pathologically involved nodes (ypT0/is ypN1-3) (5 patients) than in those without pathologically involved nodes (ypT0/is ypN0) (79 patients) (HR = 0.075, 95 % CI = 0.019 to 0.29, p = 0.0002) (Fig. 3). Among patients with ER-positive tumors, pCR was significantly predictive of better RFS if the tumors had a high Ki67 LI (p = 0.004); however, pCR was not predictive of RFS rates if tumors showed a low Ki67 LI. pCR was significantly predictive of better RFS rates in patients with tumors revealing a high Ki67 LI (HR = 0.036, 95 % CI = 0.085 to 0.82, p = 0.021), but not in patients with tumors showing a low Ki67. pCR was predictive of better RFS in patients with tumors that weakly expressed p27Kip1, (HR = 0.35, 95 % CI = 0.094 to 0.72, p = 0.010), but not in patients with tumors that strongly expressed p27Kip1.Fig. 2


ER, PgR, Ki67, p27(Kip1), and histological grade as predictors of pathological complete response in patients with HER2-positive breast cancer receiving neoadjuvant chemotherapy using taxanes followed by fluorouracil, epirubicin, and cyclophosphamide concomitant with trastuzumab.

Kurozumi S, Inoue K, Takei H, Matsumoto H, Kurosumi M, Horiguchi J, Takeyoshi I, Oyama T - BMC Cancer (2015)

Overall survival curve of pCR patients with and without lymph node metastasis. In pCR cases, OS was significantly better in patients without lymph node metastasis than in those with lymph node metastasis (HR = 13.34, p = 0.0002)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4562359&req=5

Fig3: Overall survival curve of pCR patients with and without lymph node metastasis. In pCR cases, OS was significantly better in patients without lymph node metastasis than in those with lymph node metastasis (HR = 13.34, p = 0.0002)
Mentions: The median RFS was 53 months (range, 3–108 months) and median follow-up duration was 59 months (range, 13–108 months). RFS was significantly better in the 84 patients with pCR after NAC with trastuzumab than in the 45 patients with non-pCR [hazard ratio (HR) = 0.40, 95 % CI = 0.15 to 0.79, p = 0.012] (Fig. 2). Of the 84 patients with pCR, OS was significantly worse in those with pathologically involved nodes (ypT0/is ypN1-3) (5 patients) than in those without pathologically involved nodes (ypT0/is ypN0) (79 patients) (HR = 0.075, 95 % CI = 0.019 to 0.29, p = 0.0002) (Fig. 3). Among patients with ER-positive tumors, pCR was significantly predictive of better RFS if the tumors had a high Ki67 LI (p = 0.004); however, pCR was not predictive of RFS rates if tumors showed a low Ki67 LI. pCR was significantly predictive of better RFS rates in patients with tumors revealing a high Ki67 LI (HR = 0.036, 95 % CI = 0.085 to 0.82, p = 0.021), but not in patients with tumors showing a low Ki67. pCR was predictive of better RFS in patients with tumors that weakly expressed p27Kip1, (HR = 0.35, 95 % CI = 0.094 to 0.72, p = 0.010), but not in patients with tumors that strongly expressed p27Kip1.Fig. 2

Bottom Line: A high pathological complete response (pCR) rate has been achieved using this regimen; however, the predictive factors and prognostic effects of pCR currently remain unclear.RFS was significantly better in the pCR group than in the non-pCR group (p = 0.018).Patients with remaining nodal disease in the pCR group had worse OS (p = 0.0002).

View Article: PubMed Central - PubMed

Affiliation: Division of Breast Surgery, Saitama Cancer Center, Saitama, Japan. chachagot-a-mail@hotmail.co.jp.

ABSTRACT

Background: Neoadjuvant chemotherapy (NAC) with taxanes followed by fluorouracil, epirubicin, and cyclophosphamide (FEC), and concurrent trastuzumab is a potent regimen for HER2 over-expressing breast cancer. A high pathological complete response (pCR) rate has been achieved using this regimen; however, the predictive factors and prognostic effects of pCR currently remain unclear. In the present study, we determined whether pCR was related to histological grade (HG) and several biological factors including p27(Kip1). We also assessed the prognosis of the pCR and non-pCR groups, and expected differences between those positive and negative for lymph node metastasis after chemotherapy.

Methods: A total of 129 Japanese women with HER2-positive invasive breast cancer received either paclitaxel or docetaxel followed by FEC, with the concomitant administration of trastuzumab. The statuses of HG, ER, PgR, Ki67, and p27(Kip1) were evaluated to determine their relationship with pCR. Relapse-free survival (RFS) and overall survival (OS) were also analyzed for their relationship with pCR and pathological nodal involvement.

Results: pCR was obtained in 84 out of 129 patients and the pCR rate was 65.1%. The pCR rates related to 5 factors were as follows: HG (grade 3, 70.0% vs. grades 1-2, 36.8%), ER (negative, 78.6% vs. positive, 40.0%), PgR (negative, 75.3% vs. positive, 38.9%), Ki67 (high, 72.0% vs. low, 47.2%), and p27(Kip1) (low, 71.0% vs. high, 50.0%). RFS was significantly better in the pCR group than in the non-pCR group (p = 0.018). Patients with remaining nodal disease in the pCR group had worse OS (p = 0.0002).

Conclusions: High-HG, low-ER, low-PgR, high-Ki67, and low-p27(Kip1) were identified as predictive factors of pCR in NAC with trastuzumab, while pCR and negative nodes were predictive of better survivals.

No MeSH data available.


Related in: MedlinePlus