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Pathological complete response as a surrogate for relapse-free survival in patients with triple negative breast cancer after neoadjuvant chemotherapy

View Article: PubMed Central - PubMed

ABSTRACT

We retrospective analyzed triple negative breast cancer (TNBC) patients who received either taxane-based or anthracycline-based neoadjuvant chemotherapy, evaluated whether pathological complete response (pCR) is a surrogate endpoint for relapse free survival (RFS) in TNBC and explored which subgroup of patients benefits more from superior treatment regimen. 186 patients received taxane-based (Group A) or anthracycline-based (Group B) neoadjuvant chemotherapy, median follow-up was 48.1 months. 42 patients received total pCR (ypT0/is ypN0), 34 in Group A and 8 in Group B, p < 0.001. Patients who achieved pCR had an increased RFS when compared with non-pCR patients, p = 0.043. Patients in Group A had a better RFS, p = 0.025, after adjusting for tumor size and clinical lymph node status before neoadjuvant therapy. Only patients sensitive to neoadjuvant chemotherapy exhibited RFS benefit from taxane-based treatment, and those who were treatment insensitive had similar RFS between both groups. Our analysis showed Taxane-based regimen had higher pCR rate and could predict improved RFS in TNBC, and the prognostic value was greater in treatment sensitive patients. This retrospective analysis supports the use of pCR as a surrogate endpoint for RFS in TNBC.

No MeSH data available.


Screening value of neoadjuvant chemotherapyPart 1 represents patients who are sensitive to both treatments and have better outcomes. Part 3 represents patients who are not sensitive to either treatment and have worse outcomes. A more effective regimen moves those “Part 2” patients from the treatment-insensitive group to the treatment-sensitive group as “Part 2+.”
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Figure 5: Screening value of neoadjuvant chemotherapyPart 1 represents patients who are sensitive to both treatments and have better outcomes. Part 3 represents patients who are not sensitive to either treatment and have worse outcomes. A more effective regimen moves those “Part 2” patients from the treatment-insensitive group to the treatment-sensitive group as “Part 2+.”

Mentions: We evaluated what type of patients might benefit more from the taxane-based regimens. No previous studies have provided a clear definition of “chemotherapy-sensitive tumors.” Here, we defined a tumor to be sensitive to neoadjuvant chemotherapy based on the tumor shrinkage rate. Interestingly, patients sensitive to neoadjuvant chemotherapy (no matter the cut-off value of the tumor shrinkage rate) had a trend of RFS benefit from taxane-based treatment. The HRs in different levels were quite similar, from 0.37 to 0.44, and those that were treatment-insensitive had similar outcomes, regardless of the treatment regimens. Our results indicate that responsive tumors may have actually achieved increased survival through a superior neoadjuvant regimen, which means a superior regimen could screen out more sensitive patients and provide a survival benefit for this particular subgroup of patients. Neoadjuvant treatment serves as a screening method, as shown in Figure 5, “Part 1” represents patients who are sensitive to both treatments and have better outcomes, while “Part 3” represents patients who are insensitive to either treatments and have worse outcomes. A more effective regimen moves “Part 2” patients from the treatment-insensitive to the treatment-sensitive group as “Part 2+,” improving their survival. Whether a regimen is superior or not depends on the proportion of patients in “Part 2” and the survival difference between “sensitive” and “insensitive” patients. The goal of neoadjuvant clinical trials is to test new treatment strategies in previously treatment-insensitive patients and to evaluate the number of patients who the treatment moves to the “Part 2+” group.


Pathological complete response as a surrogate for relapse-free survival in patients with triple negative breast cancer after neoadjuvant chemotherapy
Screening value of neoadjuvant chemotherapyPart 1 represents patients who are sensitive to both treatments and have better outcomes. Part 3 represents patients who are not sensitive to either treatment and have worse outcomes. A more effective regimen moves those “Part 2” patients from the treatment-insensitive group to the treatment-sensitive group as “Part 2+.”
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5392337&req=5

Figure 5: Screening value of neoadjuvant chemotherapyPart 1 represents patients who are sensitive to both treatments and have better outcomes. Part 3 represents patients who are not sensitive to either treatment and have worse outcomes. A more effective regimen moves those “Part 2” patients from the treatment-insensitive group to the treatment-sensitive group as “Part 2+.”
Mentions: We evaluated what type of patients might benefit more from the taxane-based regimens. No previous studies have provided a clear definition of “chemotherapy-sensitive tumors.” Here, we defined a tumor to be sensitive to neoadjuvant chemotherapy based on the tumor shrinkage rate. Interestingly, patients sensitive to neoadjuvant chemotherapy (no matter the cut-off value of the tumor shrinkage rate) had a trend of RFS benefit from taxane-based treatment. The HRs in different levels were quite similar, from 0.37 to 0.44, and those that were treatment-insensitive had similar outcomes, regardless of the treatment regimens. Our results indicate that responsive tumors may have actually achieved increased survival through a superior neoadjuvant regimen, which means a superior regimen could screen out more sensitive patients and provide a survival benefit for this particular subgroup of patients. Neoadjuvant treatment serves as a screening method, as shown in Figure 5, “Part 1” represents patients who are sensitive to both treatments and have better outcomes, while “Part 3” represents patients who are insensitive to either treatments and have worse outcomes. A more effective regimen moves “Part 2” patients from the treatment-insensitive to the treatment-sensitive group as “Part 2+,” improving their survival. Whether a regimen is superior or not depends on the proportion of patients in “Part 2” and the survival difference between “sensitive” and “insensitive” patients. The goal of neoadjuvant clinical trials is to test new treatment strategies in previously treatment-insensitive patients and to evaluate the number of patients who the treatment moves to the “Part 2+” group.

View Article: PubMed Central - PubMed

ABSTRACT

We retrospective analyzed triple negative breast cancer (TNBC) patients who received either taxane-based or anthracycline-based neoadjuvant chemotherapy, evaluated whether pathological complete response (pCR) is a surrogate endpoint for relapse free survival (RFS) in TNBC and explored which subgroup of patients benefits more from superior treatment regimen. 186 patients received taxane-based (Group A) or anthracycline-based (Group B) neoadjuvant chemotherapy, median follow-up was 48.1 months. 42 patients received total pCR (ypT0/is ypN0), 34 in Group A and 8 in Group B, p < 0.001. Patients who achieved pCR had an increased RFS when compared with non-pCR patients, p = 0.043. Patients in Group A had a better RFS, p = 0.025, after adjusting for tumor size and clinical lymph node status before neoadjuvant therapy. Only patients sensitive to neoadjuvant chemotherapy exhibited RFS benefit from taxane-based treatment, and those who were treatment insensitive had similar RFS between both groups. Our analysis showed Taxane-based regimen had higher pCR rate and could predict improved RFS in TNBC, and the prognostic value was greater in treatment sensitive patients. This retrospective analysis supports the use of pCR as a surrogate endpoint for RFS in TNBC.

No MeSH data available.