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De Schepper M, Nguyen HL, Richard F, Rosias L, Lerebours F, Vion R, Clatot F, Berghian A, Maetens M, Leduc S, Isnaldi E, Molinelli C, Lambertini M, Grillo F, Zoppoli G, Dirix L, Punie K, Wildiers H, Smeets A, Nevelsteen I, Neven P, Vincent-Salomon A, Larsimont D, Duhem C, Viens P, Bertucci F, Biganzoli E, Vermeulen P, Floris G, Desmedt C. Treatment Response, Tumor Infiltrating Lymphocytes and Clinical Outcomes in Inflammatory Breast Cancer-Treated with Neoadjuvant Systemic Therapy. CANCER RESEARCH COMMUNICATIONS 2024; 4:186-199. [PMID: 38147006 PMCID: PMC10807408 DOI: 10.1158/2767-9764.crc-23-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/01/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023]
Abstract
Inflammatory breast cancer (IBC) is a rare (1%-5%), aggressive form of breast cancer, accounting for approximately 10% of breast cancer mortality. In the localized setting, standard of care is neoadjuvant chemotherapy (NACT) ± anti-HER2 therapy, followed by surgery. Here we investigated associations between clinicopathologic variables, stromal tumor-infiltrating lymphocytes (sTIL), and pathologic complete response (pCR), and the prognostic value of pCR. We included 494 localized patients with IBC treated with NACT from October 1996 to October 2021 in eight European hospitals. Standard clinicopathologic variables were collected and central pathologic review was performed, including sTIL. Associations were assessed using Firth logistic regression models. Cox regressions were used to evaluate the role of pCR and residual cancer burden (RCB) on disease-free survival (DFS), distant recurrence-free survival (DRFS), and overall survival (OS). Distribution according to receptor status was as follows: 26.4% estrogen receptor negative (ER-)/HER2-; 22.0% ER-/HER2+; 37.4% ER+/HER2-, and 14.1% ER+/HER2+. Overall pCR rate was 26.3%, being highest in the HER2+ groups (45.9% for ER-/HER2+ and 42.9% for ER+/HER2+). sTILs were low (median: 5.3%), being highest in the ER-/HER2- group (median: 10%). High tumor grade, ER negativity, HER2 positivity, higher sTILs, and taxane-based NACT were significantly associated with pCR. pCR was associated with improved DFS, DRFS, and OS in multivariable analyses. RCB score in patients not achieving pCR was independently associated with survival. In conclusion, sTILs were low in IBC, but were predictive of pCR. Both pCR and RCB have an independent prognostic role in IBC treated with NACT. SIGNIFICANCE IBC is a rare, but very aggressive type of breast cancer. The prognostic role of pCR after systemic therapy and the predictive value of sTILs for pCR are well established in the general breast cancer population; however, only limited information is available in IBC. We assembled the largest retrospective IBC series so far and demonstrated that sTIL is predictive of pCR. We emphasize that reaching pCR remains of utmost importance in IBC.
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Affiliation(s)
- Maxim De Schepper
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Ha-Linh Nguyen
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - François Richard
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Louise Rosias
- Department of Gynecological and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | | | - Roman Vion
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Anca Berghian
- Anatomical Pathology Unit, Department of Biopathology, Centre Henri Becquerel, Rouen, France
| | - Marion Maetens
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Sophia Leduc
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Edoardo Isnaldi
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Chiara Molinelli
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federica Grillo
- Anatomical Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Genoa, Italy
- Department of Internal Medicine and Specialistic Medicine, U.O. Medicina Interna a Indirizzo Oncologico, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Gabriele Zoppoli
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Internal Medicine and Specialistic Medicine, U.O. Medicina Interna a Indirizzo Oncologico, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luc Dirix
- Translational Cancer Research Unit, Center for Oncological Research, Faculty of Medicine and Health Sciences, University of Antwerp, GZA hospitals, Antwerp, Belgium
| | - Kevin Punie
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Ines Nevelsteen
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Neven
- Department of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Anne Vincent-Salomon
- Department of Pathology, Université Paris Sciences Lettres, Institut Curie, Paris, France
| | - Denis Larsimont
- Department of Pathology, Institut Jules Bordet, Brussels, Belgium
| | - Caroline Duhem
- Clinique du sein, Centre Hospitalier du Luxembourg, Luxembourg
| | | | | | - Elia Biganzoli
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) “L. Sacco” & DSRC, LITA Vialba campus, University of Milan, Milan, Italy
| | - Peter Vermeulen
- Translational Cancer Research Unit, Center for Oncological Research, Faculty of Medicine and Health Sciences, University of Antwerp, GZA hospitals, Antwerp, Belgium
| | - Giuseppe Floris
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
- Laboratory for Translational Cell and Tissue Research, Department of Pathology and Imaging, KU Leuven, Belgium
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
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Shapira-Daniels A, Katz D, Aviel G, Meirovitz A, Gilon D, Shapira OM. Multimodality Treatment for Advanced Cervical Cancer With Isolated Metastasis to Interventricular Septum of the Heart. JACC CardioOncol 2020; 2:519-522. [PMID: 34396262 PMCID: PMC8352254 DOI: 10.1016/j.jaccao.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ayelet Shapira-Daniels
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Daniela Katz
- Department of Oncology, Shamir Medical Center, Beer Yaacov, Israel
| | - Gal Aviel
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amichay Meirovitz
- Department of Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Dan Gilon
- Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Department of Cardiology, Shamir Medical Center, Beer Yaacov, Israel
| | - Oz M. Shapira
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Provenzano E, Driskell OJ, O'Connor DJ, Rodriguez-Justo M, McDermott J, Wong N, Kendall T, Zhang YZ, Robinson M, Kurian KM, Pell R, Shaaban AM. The important role of the histopathologist in clinical trials: challenges and approaches to tackle them. Histopathology 2020; 76:942-949. [PMID: 32145084 DOI: 10.1111/his.14099] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/13/2022]
Abstract
High-quality histopathology is essential for the success of clinical trials. Histopathologists have a detailed understanding of tumour biology and mechanisms of disease, as well as practical knowledge of optimal tissue handling and logistical service requirements for study delivery, such as biomarker evaluation, tissue acquisition and turnaround times. As such, histopathologist input is essential throughout every stage of research and clinical trials, from concept development and study design to trial delivery, analysis and dissemination of results. Patient recruitment to trials takes place among all healthcare settings, meaning that histopathologists make an invaluable contribution to clinical trials as part of their routine day-to-day work that often goes unrecognised. More complex evaluation of surgical specimens in the neoadjuvant setting and ever-expanding minimum data sets add to the workload of every histopathologist, not just academic pathologists in tertiary centres. This is occurring against a backdrop of increasing workload pressures and a worldwide shortage of histopathologists and biomedical scientists. Providing essential histopathology support for trials at grassroots level requires funding for adequate resources including histopathologist time, education and training, biomedical scientist and administrative support and greater recognition of the contribution made by histopathology. This paper will discuss the many ways in which histopathologists are involved in clinical trials and the challenges faced in meeting the additional demands posed by trial participation and potential ways to address this, with a special emphasis on the UK model and the Cellular-Molecular Pathology Initiative (CM-Path).
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Affiliation(s)
- Elena Provenzano
- Department of Histopathology, Addenbrookes Hospital, Cambridge, UK
- Cambridge NIH Biomedical Research Centre, Cambridge, UK
| | - Owen J Driskell
- National Institute for Health Research Clinical Research Network West Midlands, Albrighton, UK
| | - Daniel J O'Connor
- Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
| | | | - Jacqueline McDermott
- Department of Cellular Pathology, University College London Hospital, London, UK
| | - Newton Wong
- Department of Cellular Pathology, Southmead Hospital, Bristol, UK
| | - Timothy Kendall
- Centre for Inflammation Research and Edinburgh Pathology, University of Edinburgh, Edinburgh, UK
| | - Yu Zhi Zhang
- National Centre for Mesothelioma Research, National Heart and Lung Institute, Imperial College London, London, UK
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle, UK
| | | | - Robert Pell
- Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Abeer M Shaaban
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
- University of Birmingham, Birmingham, UK
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Zhao Y, Wei L, Liu J, Li F. Chemoresistance was correlated with elevated expression and activity of indoleamine 2,3-dioxygenase in breast cancer. Cancer Chemother Pharmacol 2019; 85:77-93. [PMID: 31844921 DOI: 10.1007/s00280-019-04009-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Indoleamine 2,3-dioxygenase (IDO) catalyses degradation of the essential amino acid tryptophan leading to the production of immunosuppressive kynurenine and tryptophan exhausting. IDO expression and activity contribute to aggressive tumor growth, inferior therapeutic gain and poor prognosis. The aim of this study was to explore the association between chemoresistance and IDO expression, activity in breast cancer METHODS: Immunohistochemistry was applied for evaluating IDO expression in biopsy tissues. Serum IDO activity was examined via High-performance liquid chromatography (HPLC). Western blots (WB), HPLC and Real-time PCR (RT-PCR) were used to analyze IDO protein, IDO enzyme activity and IDO gene expression in original and paclitaxel-resistant cells respectively. Logistic regression and survival analysis were applied to explore the association between chemoresistance and IDO expression, activity in breast cancer. RESULTS IDO expression in tumor tissues was associated with serum IDO activity (P = 0.004). Both IDO expression in tumor and serum activity were associated with clinical tumor stage, node stage and estrogen receptor (ER) status (all P < 0.05); clinical response and pathologic complete response (pCR) to NAC were both related to IDO expression and activity prior NAC (all P < 0.05). Multivariate analysis showed IDO activity before NAC was the only independent factor affected pCR (P = 0.032). ROC curves showed that the IDO expression and activity had discriminative ability for predicting the clinical response and pCR. In the prognostic analysis, patients with high IDO expression had significantly impaired overall survival (5 year survival rate: 53.57% vs 80.00%) and progression-free survival (5 year survival rate: 46.43% vs 72.00%, P = 0.031 and P = 0.046). In vitro, significantly increased IDO protein, IDO mRNA expression and IDO enzyme activity in paclitaxel-resistant cells were demonstrated in comparing of sensitive cells. CONCLUSION IDO expression and activity associated with advanced breast cancer, poor response to neoadjuvant chemotherapy and prognosis. IDO expression and activity were significantly increased in paclitaxel-resistant breast cancer cells.
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Affiliation(s)
- Yang Zhao
- The Second Department of Breast Oncology, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Breast Surgery, Cangzhou People's Hospital, Cangzhou, 061000, Hebei, China
| | - Lijuan Wei
- Department of Cancer Prevention Center, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Hexi District, Tianjin, 300060, China
| | - Juntian Liu
- The Second Department of Breast Oncology, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Cancer Prevention Center, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Hexi District, Tianjin, 300060, China
| | - Fangxuan Li
- Department of Cancer Prevention Center, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Hexi District, Tianjin, 300060, China.
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5
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Peng Y, Chen R, Qu F, Ye Y, Fu Y, Tang Z, Wang Y, Zong B, Yu H, Luo F, Liu S. Low pretreatment lymphocyte/monocyte ratio is associated with the better efficacy of neoadjuvant chemotherapy in breast cancer patients. Cancer Biol Ther 2019; 21:189-196. [PMID: 31684807 DOI: 10.1080/15384047.2019.1680057] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The combination of some parameters, including the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and neutrophil to monocyte ratio (NMR), which are associated with patient prognosis, our goal is to find the best indicator to predict the efficacy of neoadjuvant chemotherapy(NAC)in breast cancer patients. A cohort of 808 breast cancer patients treated with NAC and subsequent surgery was analyzed retrospectively. In addition, 2424 people without breast cancer served as the normal group, which included three-fold more individuals compared with the breast cancer group. Receiver operating characteristics (ROC) curves were used to determine the optimal cutoff values of inflammatory markers and compare their predictive capacity. No significant differences in age, PLR, LMR and NMR were noted between the normal group and the patient group. However, the mean value of the NLR was significantly increased in breast cancer patients (2.28) compared with the normal population (2.04) (P < .05). The LMR was significantly associated with age (P = .003), menopausal status (P = .004), cT category (P = .017), cN category (P = .024) and response to NAC (P = .001). The multivariate analysis indicated that among these inflammatory markers, the LMR (6.1 < vs ≥ 6.1) was the only independent predictive factor for the efficacy of NAC (OR = 1.771, 95% CI = 1.273-2.464, P = .001). A low LMR is considered a favorable predicative factor of the efficacy of NAC in breast cancer patients.
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Affiliation(s)
- Yang Peng
- Department of Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Chen
- Department of Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fanli Qu
- Department of Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Ye
- Department of Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Fu
- Department of Breast Surgery, Dianjiang People's Hospital of Chongqing, Chongqing, China
| | - Zhenrong Tang
- Department of Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yihua Wang
- Department of Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Beige Zong
- Department of Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haochen Yu
- Department of Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Luo
- Department of Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shengchun Liu
- Department of Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Elevated Neutrophil-Lymphocyte Ratio in Luminal-Type Locally Advanced Breast Cancer to Circumvent Neo-Adjuvant Chemotherapy. Indian J Surg Oncol 2019; 10:454-459. [PMID: 31496590 DOI: 10.1007/s13193-019-00944-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/21/2019] [Indexed: 10/26/2022] Open
Abstract
Neutrophil-Lymphocyte Ratio (NLR) provides an understanding of the systemic inflammatory conditions. NLR plays an important role as a predictor of mortality in breast and other malignancies. The application of NLR to predict prognosis of Locally Advanced Breast Cancer (LABC) has not been well developed. In this retrospective study, we establish a relationship of pre-treatment NLR with the Pathological Complete Response (pCR) in LABC patients to enhance decision-making and treatment protocols. Data of women diagnosed with carcinoma breast between January 2015 and December 2017 was retrieved from hospital records of a tertiary medical centre in Bangalore, India, after obtaining institutional ethical clearance. LABC patients were categorized into pCR(+) and pCR(-). NLR was calculated and divided into quartiles. The cutoff NLR was determined using the Receiver Operating Characteristic (ROC) curve. Statistical analysis was performed on 119 LABC patients, of which 25 (21%) achieved pCR. Oestrogen Receptor (ER) positivity was significantly lower in pCR(+) than in pCR(-) (p = 0.012). NLR of 2.46 (AUC, 0.744; 95% CI [0.201-0.584]; p = 0.056) was considered the optimum cutoff for pCR(+). A sensitivity of 54%, specificity of 8%, positive predictive value of 1% and high Negative Predictive Value (NPV) of 84% was achieved in the study. A relationship between pCR and the pre-treatment NLR determined a significantly high NPV. Poor pCR in luminal A/B subtype presents with elevated NLR. Therefore, in luminal type A/B (ER- and PR-positive) with elevated NLR (poor outcome) and low pCR (poor response to NACT), the decision of eliminating NACT could be considered, thereby recommending surgical intervention.
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7
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Colomer R, Saura C, Sánchez-Rovira P, Pascual T, Rubio IT, Burgués O, Marcos L, Rodríguez CA, Martín M, Lluch A. Neoadjuvant Management of Early Breast Cancer: A Clinical and Investigational Position Statement. Oncologist 2019; 24:603-611. [PMID: 30710068 PMCID: PMC6516119 DOI: 10.1634/theoncologist.2018-0228] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/20/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Neoadjuvant treatment is increasingly one of the preferred therapeutic options for early breast cancer and may have some unique outcomes, such as identifying predictive and prognostic factors of response or increasing the knowledge of individual tumor biology. DESIGN A panel of experts from different specialties reviewed published clinical studies on the neoadjuvant management of breast cancer. Recommendations were made that emphasized the clinical multidisciplinary management and the investigational leverage in early breast cancer. RESULTS Neoadjuvant therapy has equivalent efficacy to adjuvant therapy, and it has some additional benefits that include increasing breast conservation, assessing tumor response, establishing prognosis based on the pathological response, and providing a "second opportunity" for nonresponding patients. Achieving pathological complete remission because of neoadjuvant therapy has been correlated with long-term clinical benefit, particularly in HER2-positive and triple-negative breast cancer. In addition, the neoadjuvant setting is a powerful model for the development of new drugs and the identification of prognostic markers. Finally, neoadjuvant therapy has proven to be cost-effective by reducing nondrug costs, avoiding radical surgery, and reducing hospital stays when compared with other treatment approaches. CONCLUSION Neoadjuvant therapy has clinical benefits in early breast cancer and provides in vivo information of individual breast cancer biology while allowing the investigation of new treatment approaches. Access to neoadjuvant therapy should be an option available to all patients with breast cancer through multidisciplinary tumor management. IMPLICATIONS FOR PRACTICE Neoadjuvant treatment should be strongly considered as a therapeutic option for localized breast cancer and is a powerful tool for understanding breast cancer biology and investigating new treatment approaches.
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Affiliation(s)
- Ramon Colomer
- Department of Medical Oncology, Hospital Universitario La Princesa, Madrid, Spain
| | - Cristina Saura
- Department of Medical Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Tomás Pascual
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
- Translational Genomic and Targeted Therapeutics in Solid Tumors, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Isabel T Rubio
- Department of Breast Surgical Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Octavio Burgués
- Pathology Department, Hospital Clínico Universitario, Valencia, Spain
| | - Lourdes Marcos
- Department of Radiology, Hospital Universitario La Princesa, Madrid, Spain
| | - César A Rodríguez
- Department of Medical Oncology, Hospital Clínico Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Miguel Martín
- Department of Medical Oncology, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - Ana Lluch
- Department of Medical Oncology and Hematology, Hospital Clínico Universitario, University of Valencia-INCLIVA Health Research Institute, CIBERONC, Valencia, Spain
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8
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Mrkonjic M, Berman HK, Done SJ, Youngson B, Mulligan AM. Breast specimen handling and reporting in the post-neoadjuvant setting: challenges and advances. J Clin Pathol 2019; 72:120-132. [PMID: 30670564 DOI: 10.1136/jclinpath-2018-205598] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/23/2022]
Abstract
Neoadjuvant systemic therapy is becoming more commonly used in patients with earlier stages of breast cancer. To assess tumour response to neoadjuvant chemotherapy, pathological evaluation is the gold standard. Depending on the treatment response, the pathological examination of these specimens can be quite challenging. However, a uniform approach to evaluate post-neoadjuvant-treated breast specimens has been lacking. Furthermore, there is no single universally accepted or endorsed classification system for assessing treatment response in this setting. Recent initiatives have attempted to create a standardised protocol for evaluation of post-neoadjuvant breast specimens. This review outlines the necessary information that should be collected prior to macroscopic examination of these specimens, the recommended and most pragmatic approach to tissue sampling for microscopic examination, describes the macroscopic and microscopic features of post-therapy breast specimens, summarises two commonly used systems for classifying treatment response and outlines the critical variables that should be included in the final pathology report.
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Affiliation(s)
- Miralem Mrkonjic
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Hal K Berman
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Susan J Done
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Bruce Youngson
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Anna Marie Mulligan
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada .,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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9
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Vallacha A, Haider G, Raja W, Kumar D. Quality of Breast Cancer Surgical Pathology Reports. Asian Pac J Cancer Prev 2018; 19:853-858. [PMID: 29582645 PMCID: PMC5980866 DOI: 10.22034/apjcp.2018.19.3.853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Surgical pathology reporting of breast cancer is needed for appropriate staging and treatment decisions.
We here checked the quality of surgical pathology reports of breast cancer from different laboratories of Karachi,
Pakistan. Methods: One hundred surgical pathology reports from ten different laboratories of Karachi were assessed
for documentation of elements against a checklist adopted from the CAP guideline over a period of six months from
January, 2017 to June, 2017 in the Oncology Department, Jinnah Postgraduate Medical Centre, Karachi. Results: Out
of 100 reports, clinical information was documented in 68%, type of procedure and lymph node sampling in 84%
and 34% respectively. Specimen laterality was mentioned in 90%, tumor site in 44%, tumor size in 92%, focality in
40%, histological type in 96%, grade in 87%, LCIS in 19%, DCIS in 83%, size of DCIS in 19%, architectural pattern
in 26% , nuclear grade in 17%, necrosis in 14%, excision margin status in 91%, invasive component in 83%, DCIS in
16%, lymph node status in 91% with positive nodes in 56%, size of macro met in 54%, extranodal involvement in 48%,
lymph vascular invasion in 86%, treatment effects in 31%, and pathology reporting with TNM in 57%. Conclusion:
This study shows that the quality of surgical pathology reports for breast cancer in Karachi is not satisfactory. Therefore,
there is great need to create awareness among histopathologists regarding the importance of accurate breast cancer
surgical pathology reporting and to introduce a standardized checklist according to international guidelines for better
treatment planning.
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Affiliation(s)
- Anita Vallacha
- Department of Oncology, Jinnah Postgraduate Medical Center, Karachi, Sindh, Pakistan.
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10
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Burgués O, López-García MÁ, Pérez-Míes B, Santiago P, Vieites B, García JF, Peg V. The ever-evolving role of pathologists in the management of breast cancer with neoadjuvant treatment: recommendations based on the Spanish clinical experience. Clin Transl Oncol 2017; 20:382-391. [PMID: 28795336 DOI: 10.1007/s12094-017-1725-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/25/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the current international standards for neoadjuvant systemic therapy (NAST) protocols, and establish consensus recommendations by Spanish breast pathologists; and to look into the Spanish reality of defining pathological complete response in daily practice. MATERIALS AND METHODS A modified Delphi technique was used to gain consensus among a panel of 46 experts with regard to important issues about NAST specimens, with the objective of standardize handling and analysis of these breast cancer specimens. In addition, a survey was conducted among 174 pathologists to explore the Spanish reality of post-NAST breast cancer specimens handling. RESULTS Our survey shows that pathologists in Spain follow the same guidelines as their international colleagues and face the same problems and controversies. Among the experts, 94.1% agreed on the recommendation for a pre-treatment evaluation with a core needle biopsy, and 100% of experts agreed on the need of having properly indicated information for the post-NAST surgical specimens. However, only 82.7% of them receive properly labelled specimens and even less receive specimens where markers are identified and the degree of clinical/radiological response is mentioned. Among participants 59.9% were familiar with the residual cancer burden system for post-NAST response quantification, but only 16.1% used it regularly. CONCLUSIONS Active participation on breast cancer multidisciplinary teams, optimal usage of core needle biopsy for timely and standardized procedures for the diagnostic analysis, and accurate diagnosis of pathological complete response and complete evaluation of the response to NAST need to become the standard practice when handling breast cancer specimens in Spain.
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Affiliation(s)
- O Burgués
- Servicio de Anatomía Patológica, Hospital Clínico Universitario, Avda. Blasco Ibáñez, 17, 46010, Valencia, Spain.
| | - Mª Á López-García
- Servicio de Anatomía Patológica, Hospital Virgen Del Rocío, Seville, Spain
| | - B Pérez-Míes
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - P Santiago
- Servicio de Anatomía Patológica, Complejo Hospitalario A Coruña, A Coruña, Spain
| | - B Vieites
- Servicio de Anatomía Patológica, Hospital Virgen Del Rocío, Seville, Spain
| | | | - V Peg
- Servicio de Anatomía Patológica, Hospital Vall d'Hebron, Barcelona, Spain
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11
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Thomas JSJ, Provenzano E, Hiller L, Dunn J, Blenkinsop C, Grybowicz L, Vallier AL, Gounaris I, Abraham J, Hughes-Davies L, McAdam K, Chan S, Ahmad R, Hickish T, Houston S, Rea D, Caldas C, Bartlett JM, Cameron DA, Hayward RL, Earl HM. Central pathology review with two-stage quality assurance for pathological response after neoadjuvant chemotherapy in the ARTemis Trial. Mod Pathol 2017; 30:1069-1077. [PMID: 28548129 DOI: 10.1038/modpathol.2017.30] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/15/2017] [Accepted: 02/19/2017] [Indexed: 12/17/2022]
Abstract
The ARTemis Trial tested standard neoadjuvant chemotherapy±bevacizumab in the treatment of HER2-negative early breast cancer. We compare data from central pathology review with report review and also the reporting behavior of the two central pathologists. Eight hundred women with HER2-negative early invasive breast cancer were recruited. Response to chemotherapy was assessed from local pathology reports for pathological complete response in breast and axillary lymph nodes. Sections from the original core biopsy and surgical excision were centrally reviewed by one of two trial pathologists blinded to the local pathology reports. Pathologists recorded response to chemotherapy descriptively and also calculated residual cancer burden. 10% of cases were double-reported to compare the central pathologists' reporting behavior. Full sample retrieval was obtained for 681 of the 781 patients (87%) who underwent surgery within the trial and were evaluable for pathological complete response. Four hundred and eighty-three (71%) were assessed by JSJT, and 198 (29%) were assessed by EP. Residual cancer burden calculations were possible in 587/681 (86%) of the centrally reviewed patients, as 94/681 (14%) had positive sentinel nodes removed before neoadjuvant chemotherapy invalidating residual cancer burden scoring. Good concordance was found between the two pathologists for residual cancer burden classes within the 65-patient quality assurance exercise (kappa 0.63 (95% CI: 0.57-0.69)). Similar results were obtained for the between-treatment arm comparison both from the report review and the central pathology review. For pathological complete response, report review was as good as central pathology review but for minimal residual disease, report review overestimated the extent of residual disease. In the ARTemis Trial central pathology review added little in the determination of pathological complete response but had a role in evaluating low levels of residual disease. Calculation of residual cancer burden was a simple and reproducible method of quantifying response to neoadjuvant chemotherapy as demonstrated by performance comparison of the two pathologists.
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Affiliation(s)
| | - Elena Provenzano
- NIHR Cambridge Biomedical Research Centre, Addenbrookes Hospital, Cambridge, UK
- Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Histopathology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Louise Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Janet Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Clare Blenkinsop
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Louise Grybowicz
- Cambridge Clinical Trials Unit-Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anne-Laure Vallier
- Cambridge Clinical Trials Unit-Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ioannis Gounaris
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Jean Abraham
- NIHR Cambridge Biomedical Research Centre, Addenbrookes Hospital, Cambridge, UK
- Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Luke Hughes-Davies
- University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Karen McAdam
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Peterborough City Hospital, Edith Cavell Campus, Peterborough, UK
| | - Stephen Chan
- Nottingham University Hospital (City Campus), Nottingham, UK
| | | | - Tamas Hickish
- Poole Hospital NHS Foundation Trust, Poole, UK
- Bournemouth University, Poole, UK
| | - Stephen Houston
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Daniel Rea
- Institute for Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Carlos Caldas
- NIHR Cambridge Biomedical Research Centre, Addenbrookes Hospital, Cambridge, UK
- Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
| | - John Ms Bartlett
- Ontario Institute for Cancer Research, MaRS Centre, Toronto, ON, Canada
| | - David Allan Cameron
- University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | | | - Helena Margaret Earl
- NIHR Cambridge Biomedical Research Centre, Addenbrookes Hospital, Cambridge, UK
- Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
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12
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Aharon A, Sabbah A, Ben-Shaul S, Berkovich H, Loven D, Brenner B, Bar-Sela G. Chemotherapy administration to breast cancer patients affects extracellular vesicles thrombogenicity and function. Oncotarget 2017; 8:63265-63280. [PMID: 28968987 PMCID: PMC5609919 DOI: 10.18632/oncotarget.18792] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/23/2017] [Indexed: 12/15/2022] Open
Abstract
Breast cancer (BC) is the most prevalent type of malignancy in women. Extracellular vesicles (EVs) are subcellular membrane blebs that include exosomes and microparticles.
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Affiliation(s)
- Anat Aharon
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Anni Sabbah
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Shahar Ben-Shaul
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Hila Berkovich
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - David Loven
- Department of Oncology, Ha'emek Medical Center, Afula, Israel
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Bar-Sela
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Oncology, Rambam Health Care Campus, Haifa, Israel
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13
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Predictive Clinicopathologic and Dynamic Contrast-Enhanced MRI Findings for Tumor Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer. AJR Am J Roentgenol 2017; 208:W225-W230. [DOI: 10.2214/ajr.16.17125] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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14
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Masood S. Neoadjuvant chemotherapy in breast cancers. WOMEN'S HEALTH (LONDON, ENGLAND) 2016; 12:480-491. [PMID: 27885165 PMCID: PMC5373271 DOI: 10.1177/1745505716677139] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/22/2016] [Accepted: 10/03/2016] [Indexed: 12/20/2022]
Abstract
With advances in science and technology, there are more innovations in the approach to management of patients with breast cancer. Neoadjuvant chemotherapy that is designed to be used prior to surgical removal of a tumor has received significant attention. Currently, neoadjuvant chemotherapy is offered to patients with locally advanced breast cancer and also those breast cancer patients who may benefit from size reduction before conservation therapy. There is now sufficient evidence that if neoadjuvant chemotherapy leads to complete pathologic response, the patient will enjoy a better outcome. Therefore, assessment of the degree of response to neoadjuvant chemotherapy has a major impact on patient selection and the follow-up management of each patient and defines patient outcome.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Female
- Humans
- Mastectomy
- Mastectomy, Segmental
- Neoadjuvant Therapy/methods
- Neoplasm Staging
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Treatment Outcome
- Tumor Burden
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Affiliation(s)
- Shahla Masood
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- UF Health Breast Center, University of Florida Health-Jacksonville, Jacksonville, FL, USA
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15
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Marchiò C, Maletta F, Annaratone L, Sapino A. The Perfect Pathology Report After Neoadjuvant Therapy. J Natl Cancer Inst Monogr 2016; 2015:47-50. [PMID: 26063886 DOI: 10.1093/jncimonographs/lgv016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Neoadjuvant therapy is increasingly being used in the management of breast cancer patients and, since comprehensive specimen handling and precise histological reporting is essential to assess the degree of response to therapy, histopathologists are acknowledged to play a key role in this multidisciplinary setting. However, as a matter of fact, only minimal guidelines for specimen handling are on record. This means that in every day routine practice it is not uncommon for oncologists to deal with pathology reports where important parameters are missing (such as formal comments about therapy response). According to the latest American Joint Committee on Cancer (AJCC) staging classification, posttreatment size of residual disease (ypT) should be estimated based on the best combination of imaging, gross and microscopic histological findings. Therefore, pathologists should ideally be provided with clinical and radiological information before proceeding with careful grossing. During the cut-up, large sections or extensive mapping of samples submitted to microscopic evaluation should be carried out to reconstruct the disease extent: this is particularly crucial when the lesion is unapparent both at imaging and at macroscopic observation. Histopathological reports cannot preclude from mandatory information about the presence of residual invasive carcinoma, such as histotyping, staging (ypTNM), reevaluation of prognostic and predictive factors, and categorization of degree of response according to dedicated classification systems (performed by comparing pretreatment biopsies with surgical specimens). In this review we will analyze the critical issues in such an assessment and we will provide a pragmatic approach with the intent to aim at the "perfect" pathology report.
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Affiliation(s)
- Caterina Marchiò
- Department of Medical Sciences, University of Turin, Turin, Italy (CM, FM, LA, AS)
| | - Francesca Maletta
- Department of Medical Sciences, University of Turin, Turin, Italy (CM, FM, LA, AS)
| | - Laura Annaratone
- Department of Medical Sciences, University of Turin, Turin, Italy (CM, FM, LA, AS)
| | - Anna Sapino
- Department of Medical Sciences, University of Turin, Turin, Italy (CM, FM, LA, AS).
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16
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Ali HR, Dariush A, Provenzano E, Bardwell H, Abraham JE, Iddawela M, Vallier AL, Hiller L, Dunn JA, Bowden SJ, Hickish T, McAdam K, Houston S, Irwin MJ, Pharoah PDP, Brenton JD, Walton NA, Earl HM, Caldas C. Computational pathology of pre-treatment biopsies identifies lymphocyte density as a predictor of response to neoadjuvant chemotherapy in breast cancer. Breast Cancer Res 2016; 18:21. [PMID: 26882907 PMCID: PMC4755003 DOI: 10.1186/s13058-016-0682-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/01/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a need to improve prediction of response to chemotherapy in breast cancer in order to improve clinical management and this may be achieved by harnessing computational metrics of tissue pathology. We investigated the association between quantitative image metrics derived from computational analysis of digital pathology slides and response to chemotherapy in women with breast cancer who received neoadjuvant chemotherapy. METHODS We digitised tissue sections of both diagnostic and surgical samples of breast tumours from 768 patients enrolled in the Neo-tAnGo randomized controlled trial. We subjected digital images to systematic analysis optimised for detection of single cells. Machine-learning methods were used to classify cells as cancer, stromal or lymphocyte and we computed estimates of absolute numbers, relative fractions and cell densities using these data. Pathological complete response (pCR), a histological indicator of chemotherapy response, was the primary endpoint. Fifteen image metrics were tested for their association with pCR using univariate and multivariate logistic regression. RESULTS Median lymphocyte density proved most strongly associated with pCR on univariate analysis (OR 4.46, 95 % CI 2.34-8.50, p < 0.0001; observations = 614) and on multivariate analysis (OR 2.42, 95 % CI 1.08-5.40, p = 0.03; observations = 406) after adjustment for clinical factors. Further exploratory analyses revealed that in approximately one quarter of cases there was an increase in lymphocyte density in the tumour removed at surgery compared to diagnostic biopsies. A reduction in lymphocyte density at surgery was strongly associated with pCR (OR 0.28, 95 % CI 0.17-0.47, p < 0.0001; observations = 553). CONCLUSIONS A data-driven analysis of computational pathology reveals lymphocyte density as an independent predictor of pCR. Paradoxically an increase in lymphocyte density, following exposure to chemotherapy, is associated with a lack of pCR. Computational pathology can provide objective, quantitative and reproducible tissue metrics and represents a viable means of outcome prediction in breast cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT00070278 ; 03/10/2003.
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Affiliation(s)
- H Raza Ali
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK.
- Department of Pathology, University of Cambridge, Cambridge, UK.
| | | | - Elena Provenzano
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
| | - Helen Bardwell
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK.
| | - Jean E Abraham
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
| | - Mahesh Iddawela
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
- Present address: Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia.
| | - Anne-Laure Vallier
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
| | - Louise Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
| | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
| | - Sarah J Bowden
- Cancer Research UK Clinical Trials Unit, Institute for Cancer Studies, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Tamas Hickish
- Royal Bournemouth Hospital and Bournemouth University, Castle Lane East, Bournemouth, UK.
| | - Karen McAdam
- Peterborough and Stamford Hospitals NHS Foundation Trust and Cambridge University Hospital NHS Foundation Trust, Peterborough, UK.
| | - Stephen Houston
- Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, UK.
| | - Mike J Irwin
- Institute of Astronomy, University of Cambridge, Cambridge, UK.
| | - Paul D P Pharoah
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
| | - James D Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK.
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
| | | | - Helena M Earl
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
| | - Carlos Caldas
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK.
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
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17
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Suppan C, Bjelic-Radisic V, La Garde M, Groselj-Strele A, Eberhard K, Samonigg H, Loibner H, Dandachi N, Balic M. Neutrophil/Lymphocyte ratio has no predictive or prognostic value in breast cancer patients undergoing preoperative systemic therapy. BMC Cancer 2015; 15:1027. [PMID: 26715527 PMCID: PMC4696229 DOI: 10.1186/s12885-015-2005-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/15/2015] [Indexed: 01/26/2023] Open
Abstract
Background The primary goal of preoperative systemic treatment (PST) in patients with breast cancer is downsizing of tumors to enhance the rate of breast conserving surgery. Additionally, preoperative systemic treatment offers the possibility to assess for chemosensitivity of early stage disease. In various cancers the prognostic value of neutrophil/lymphocyte ratio (NLR) was demonstrated, indicating that high NLR determines worse prognosis of the patients. The goal of our study was to evaluate the predictive and prognostic value of NLR in early stage breast cancer patients undergoing PST. Methods 247 female patients with histologically proven breast cancer were analysed in this retrospective analysis. The NLR before the initiation of PST was documented. Histopathological response in surgically removed specimens was evaluated using a modified Sinn regression score and the pCR defined as no invasive tumor in primary tumor and lymph nodes. NLR was correlated with response to PST and disease free survival. Results PST was categorized into five groups (anthracycline containing, anthracycline and taxane containing, taxane containing, hormone treatment and other chemotherapies). pCR rate was defined as no invasive rest of tumor either in primary tumor or (ypT0 = Sinn) or in primary tumor and in lymph nodes (ypT0isypN0). Median NLR in patients without any invasive tumor rest was significantly higher than in patients either with some invasive tumor rest or not responding to chemotherapy. Despite this primary difference, the results were not stable across the analysed treatment groups particularly in the group with highest pCR rates (taxane and anthracycline treatment). Further, no association with disease free survival could be observed. Conclusions Although there was a reverse trend with the higher NLR prior to systemic treatment in patients who achieved pCR, we could not demonstrate predictive or prognostic value of NLR in the cohort of early stage breast cancer patients treated with PST.
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Affiliation(s)
- Christoph Suppan
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Vesna Bjelic-Radisic
- Department of Gynaecology and Obstetrics, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria.
| | - Marlen La Garde
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. .,Department of Gynaecology and Obstetrics, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria.
| | - Andrea Groselj-Strele
- Research Facility for Biostatistics, Center for Medical Research, Medical University of Graz, Stiftingtalstraße 24, 8010, Graz, Austria.
| | - Katharina Eberhard
- Research Facility for Biostatistics, Center for Medical Research, Medical University of Graz, Stiftingtalstraße 24, 8010, Graz, Austria.
| | - Hellmut Samonigg
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Hans Loibner
- Apeiron Biologics AG, Campus-Vienna-Biocenter 5, 1030, Vienna, Austria.
| | - Nadia Dandachi
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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18
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Earl H, Provenzano E, Abraham J, Dunn J, Vallier AL, Gounaris I, Hiller L. Neoadjuvant trials in early breast cancer: pathological response at surgery and correlation to longer term outcomes - what does it all mean? BMC Med 2015; 13:234. [PMID: 26391216 PMCID: PMC4578850 DOI: 10.1186/s12916-015-0472-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neoadjuvant breast cancer trials are important for speeding up the introduction of new treatments for patients with early breast cancer and for the highly productive translational research which they facilitate. Meta-analysis of trial data shows clear correlation between pathological response at surgery after neoadjuvant chemotherapy and longer-term outcomes at an individual patient level. However, this does not appear to be present on individual trial level analysis, when correlating improved outcome for the investigational arm for the primary endpoint (pathological response) with longer-term outcomes. DISCUSSION The correlation between pathological response and longer-term outcomes in trials is dependent on many factors. These include definitions of pathological response, both complete and partial; assessment methods for pathological response at surgery; subtype and prognosis of breast cancer at diagnosis; number of patients recruited; adjuvant treatments; the mechanism of action of the investigational drug; the length of follow-up at the time of reporting; the definitions used in longer-term outcomes analysis; clonal heterogeneity; and new adaptive trial designs with additional neo/adjuvant treatments. Future developments of neoadjuvant breast cancer trials are discussed. With so many factors influencing the correlation of longer-term outcomes for trial-level data, we conclude that the main focus of neoadjuvant trials should remain the primary endpoint of pathological response. Neoadjuvant breast cancer trials are very important investigational studies that will continue to increase our understanding of the disease and offer the potential of more rapid introduction of new treatments for women with high-risk early breast cancer. In the future, we are likely to see both novel trial designs adopted in the neoadjuvant context and modifications of neo/adjuvant treatments for pathological non-responders within clinical trials. Both of these have the intention of improving longer-term outcomes for patients who do not have a good pathological response to first-line neoadjuvant treatment. If successful, these developments are likely to reduce further any positive correlation between pathological response and longer-term outcomes.
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Affiliation(s)
- Helena Earl
- Department of Oncology, University of Cambridge, Cambridge, UK. .,NIHR Cambridge Biomedical Research Centre and Cambridge Experimental Cancer Medicine Centre, Cambridge, UK. .,Cambridge Breast Research Unit, Cambridge, UK. .,Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
| | - Elena Provenzano
- NIHR Cambridge Biomedical Research Centre and Cambridge Experimental Cancer Medicine Centre, Cambridge, UK. .,Cambridge Breast Research Unit, Cambridge, UK. .,Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
| | - Jean Abraham
- Department of Oncology, University of Cambridge, Cambridge, UK. .,NIHR Cambridge Biomedical Research Centre and Cambridge Experimental Cancer Medicine Centre, Cambridge, UK. .,Cambridge Breast Research Unit, Cambridge, UK. .,Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
| | - Janet Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
| | - Anne-Laure Vallier
- Cambridge Breast Research Unit, Cambridge, UK. .,Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
| | - Ioannis Gounaris
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK. .,Cancer Research UK Cambridge Institute, Cambridge, UK.
| | - Louise Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
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19
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Provenzano E, Bossuyt V, Viale G, Cameron D, Badve S, Denkert C, MacGrogan G, Penault-Llorca F, Boughey J, Curigliano G, Dixon JM, Esserman L, Fastner G, Kuehn T, Peintinger F, von Minckwitz G, White J, Yang W, Symmans WF. Standardization of pathologic evaluation and reporting of postneoadjuvant specimens in clinical trials of breast cancer: recommendations from an international working group. Mod Pathol 2015; 28:1185-201. [PMID: 26205180 DOI: 10.1038/modpathol.2015.74] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/09/2015] [Indexed: 01/02/2023]
Abstract
Neoadjuvant systemic therapy is being used increasingly in the treatment of early-stage breast cancer. Response, in the form of pathological complete response, is a validated and evaluable surrogate end point of survival after neoadjuvant therapy. Thus, pathological complete response has become a primary end point for clinical trials. However, there is a current lack of uniformity in the definition of pathological complete response. A review of standard operating procedures used by 28 major neoadjuvant breast cancer trials and/or 25 sites involved in such trials identified marked variability in specimen handling and histologic reporting. An international working group was convened to develop practical recommendations for the pathologic assessment of residual disease in neoadjuvant clinical trials of breast cancer and information expected from pathology reports. Systematic sampling of areas identified by informed mapping of the specimen and close correlation with radiological findings is preferable to overly exhaustive sampling, and permits taking tissue samples for translational research. Controversial areas are discussed, including measurement of lesion size, reporting of lymphovascular space invasion and the presence of isolated tumor cells in lymph nodes after neoadjuvant therapy, and retesting of markers after treatment. If there has been a pathological complete response, this must be clearly stated, and the presence/absence of residual ductal carcinoma in situ must be described. When there is residual invasive carcinoma, a comment must be made as to the presence/absence of chemotherapy effect in the breast and lymph nodes. The Residual Cancer Burden is the preferred method for quantifying residual disease in neoadjuvant clinical trials in breast cancer; other methods can be included per trial protocols and regional preference. Posttreatment tumor staging using the Tumor-Node-Metastasis system should be included. These recommendations for standardized pathological evaluation and reporting of neoadjuvant breast cancer specimens should improve prognostication for individual patients and allow comparison of treatment outcomes within and across clinical trials.
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Affiliation(s)
- Elena Provenzano
- Department of Histopathology and NIH Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Veerle Bossuyt
- Department of Pathology, Yale University, New Haven, CT, USA
| | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology and University of Milan, Milan, Italy
| | - David Cameron
- Edinburgh Cancer Research UK Centre,University of Edinburgh, Edinburgh, UK
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | - Judy Boughey
- Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA
| | - Giuseppe Curigliano
- Early Drug Development for Innovative Therapies Division, European Institute of Oncology, Milan, Italy
| | - J Michael Dixon
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - Laura Esserman
- Carol Franc Buck Breast Care Center, University of California, San Francisco, CA, USA
| | - Gerd Fastner
- Department of Radiotherapy and Radiation Oncology, Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
| | - Thorsten Kuehn
- Department of Gynecology and Obstetrics, Interdisciplinary Breast Center, Klinikum Esslingen, Esslingen, Germany
| | - Florentia Peintinger
- Institute of Pathology, Medical University of Graz, Graz, Austria.,Department of Gynecology, General Hospital Leoben, Leoben, Austria
| | - Gunter von Minckwitz
- German Breast Group, Neu-Isenburg, and Department of Gynecology and Obstetrics, University Women's Hospital, Frankfurt, Germany
| | - Julia White
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Wei Yang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - W Fraser Symmans
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Peintinger F, Sinn B, Hatzis C, Albarracin C, Downs-Kelly E, Morkowski J, Gould R, Symmans WF. Reproducibility of residual cancer burden for prognostic assessment of breast cancer after neoadjuvant chemotherapy. Mod Pathol 2015; 28:913-20. [PMID: 25932963 PMCID: PMC4830087 DOI: 10.1038/modpathol.2015.53] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/17/2015] [Accepted: 02/25/2015] [Indexed: 01/04/2023]
Abstract
The residual cancer burden index was developed as a method to quantify residual disease ranging from pathological complete response to extensive residual disease. The aim of this study was to evaluate the inter-Pathologist reproducibility in the residual cancer burden index score and category, and in their long-term prognostic utility. Pathology slides and pathology reports of 100 cases from patients treated in a randomized neoadjuvant trial were reviewed independently by five pathologists. The size of tumor bed, average percent overall tumor cellularity, average percent of the in situ cancer within the tumor bed, size of largest axillary metastasis, and number of involved nodes were assessed separately by each pathologist and residual cancer burden categories were assigned to each case following calculation of the numerical residual cancer burden index score. Inter-Pathologist agreement in the assessment of the continuous residual cancer burden score and its components and agreement in the residual cancer burden category assignments were analyzed. The overall concordance correlation coefficient for the agreement in residual cancer burden score among pathologists was 0.931 (95% confidence interval (CI) 0.908-0.949). Overall accuracy of the residual cancer burden score determination was 0.989. The kappa coefficient for overall agreement in the residual cancer burden category assignments was 0.583 (95% CI 0.539-0.626). The metastatic component of the residual cancer burden index showed stronger concordance between pathologists (overall concordance correlation coefficient=0.980; 95% CI 0.954-0.992), than the primary component (overall concordance correlation coefficient=0.795; 95% CI 0.716-0.853). At a median follow-up of 12 years residual cancer burden determined by each of the pathologists had the same prognostic accuracy for distant recurrence-free and survival (overall concordance correlation coefficient=0.995; 95% CI 0.989-0.998). Residual cancer burden assessment is highly reproducible, with reproducible long-term prognostic significance.
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Affiliation(s)
- Florentia Peintinger
- Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036 Graz, Austria,Department of Gynecology, General Hospital Leoben, Vordernbergerstrasse 42, 8700 Leoben, Austria
| | - Bruno Sinn
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States
| | - Christos Hatzis
- Yale Comprehensive Cancer Center, Yale School of Medicine, 333 Cedar Street, PO Box 208032, New Haven, CT 06520-8032, United States
| | - Constance Albarracin
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States
| | - Erinn Downs-Kelly
- Department of Pathology, Huntsman Cancer Hospital, University of Utah, 1950 Circle of Hope, Salt Lake City, UT 84112, United States
| | - Jerzy Morkowski
- MLD Pathology, 1140 Business Center Drive, Suite 370, Houston, TX 77043, United States
| | - Rebekah Gould
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States
| | - W. Fraser Symmans
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States
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18F-FLT PET/CT as an imaging tool for early prediction of pathological response in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy: a pilot study. Eur J Nucl Med Mol Imaging 2015; 42:818-30. [DOI: 10.1007/s00259-015-2995-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/14/2015] [Indexed: 02/07/2023]
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Bonnefoi H, Jacot W, Saghatchian M, Moldovan C, Venat-Bouvet L, Zaman K, Matos E, Petit T, Bodmer A, Quenel-Tueux N, Chakiba C, Vuylsteke P, Jerusalem G, Brain E, Tredan O, Messina CGM, Slaets L, Cameron D. Neoadjuvant treatment with docetaxel plus lapatinib, trastuzumab, or both followed by an anthracycline-based chemotherapy in HER2-positive breast cancer: results of the randomised phase II EORTC 10054 study. Ann Oncol 2014; 26:325-32. [PMID: 25467016 DOI: 10.1093/annonc/mdu551] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Neoadjuvant trials conducted using a double HER2 blockade with lapatinib and trastuzumab, combined with different paclitaxel-containing chemotherapy regimens, have shown high pathological complete response (pCR) rates, but at the cost of important toxicity. We hypothesised that this toxicity might be due to a specific interaction between paclitaxel and lapatinib. This trial assesses the toxicity and activity of the combination of docetaxel with lapatinib and trastuzumab. PATIENTS AND METHODS Patients with stage IIA to IIIC HER2-positive breast cancer received six cycles of chemotherapy (three cycles of docetaxel followed by three cycles of fluorouracil, epirubicin, cyclophosphamide). They were randomised 1 : 1 : 1 to receive during the first three cycles either lapatinib (1000 mg orally daily), trastuzumab (4 mg/kg loading dose followed by 2 mg/kg weekly), or trastuzumab + lapatinib at the same dose. The primary end point was pCR rate defined as ypT0/is. Secondary end points included safety and toxicity. pCR rate defined as ypT0/is ypN0 was assessed as an exploratory analysis. In June 2012, arm A was closed for futility based on the results from other studies. RESULTS From October 2010 to January 2013, 128 patients were included in 14 centres. The percentage of the 122 assessable patients with pCR in the breast, and pCR in the breast and nodes, was numerically highest in the lapatinib + trastuzumab group (60% and 56%, respectively), intermediate in the trastuzumab group (52% and 52%), and lowest in the lapatinib group (46% and 36%). Frequency (%) of the most common grade 3-4 toxicities in the lapatinib /trastuzumab/lapatinib + trastuzumab arms were: febrile neutropenia 23/15/10, diarrhoea 9/2/18, infection (other) 9/4/8, and hepatic toxicity 0/2/8. CONCLUSIONS This study demonstrates a numerically modest pCR rate increase with double anti-HER2 blockade plus chemotherapy, but suggests that the use of docetaxel rather than paclitaxel may not reduce toxicity. CLINICALTRIALSGOV NCT00450892.
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Affiliation(s)
- H Bonnefoi
- Department of Medical Oncology, Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U916, Bordeaux
| | - W Jacot
- Department of Medical Oncology, Centre Val D'Aurelle-Paul Lamarque, Montpellier
| | - M Saghatchian
- Department of Medical Oncology, Gustave Roussy, Villejuif
| | - C Moldovan
- Department of Medical Oncology, Centre Henri Becquerel, Rouen
| | - L Venat-Bouvet
- Department of Medical Oncology, Centre Hospitalier Universitaire, Limoges, France
| | - K Zaman
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - E Matos
- Department of Medical Oncology, Institute of Oncology, Ljubljana, Ljubljana University Clinic, Golnik, Slovenia
| | - T Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
| | - A Bodmer
- Gyneco-Oncology Unit, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - N Quenel-Tueux
- Department of Medical Oncology, Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U916, Bordeaux
| | - C Chakiba
- Department of Medical Oncology, Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U916, Bordeaux
| | - P Vuylsteke
- Department of Medical Oncology, Hôpital St Elisabeth, Namur
| | - G Jerusalem
- Department of Medical Oncology, Centre Hospitalier Universitaire (Sart Tilman), Liege, Belgium
| | - E Brain
- Medical Oncology and Clinical Research Unit, Ensemble Hospitalier de L'Institut Curie, Hôpital René Huguenin, St-Cloud
| | - O Tredan
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - C G M Messina
- Department of Statistics, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - L Slaets
- Department of Statistics, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - D Cameron
- Edinburgh Breast Unit and Edinburgh University Cancer Research Centre, Western General Hospital, Edinburgh, UK
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Rivera DS, Wijnen JP, van der Kemp WJM, Raaijmakers AJ, Luijten PR, Klomp DWJ. MRI and 31
P magnetic resonance spectroscopy hardware for axillary lymph node investigation at 7T. Magn Reson Med 2014; 73:2038-46. [DOI: 10.1002/mrm.25304] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Debra S. Rivera
- Department of Neurophysics; Max Planck Institute for Human Cognitive and Brain Sciences; Leipzig Germany
| | - Jannie P. Wijnen
- Department of Radiology; University Medical Center Utrecht; Utrecht the Netherlands
| | | | | | - Peter R. Luijten
- Department of Radiology; University Medical Center Utrecht; Utrecht the Netherlands
| | - Dennis W. J. Klomp
- Department of Radiology; University Medical Center Utrecht; Utrecht the Netherlands
- Department of Radiology; University Medical Center Nijmegen; Nijmegen the Netherlands
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Bonnefoi H, Litière S, Piccart M, MacGrogan G, Fumoleau P, Brain E, Petit T, Rouanet P, Jassem J, Moldovan C, Bodmer A, Zaman K, Cufer T, Campone M, Luporsi E, Malmström P, Werutsky G, Bogaerts J, Bergh J, Cameron DA. Pathological complete response after neoadjuvant chemotherapy is an independent predictive factor irrespective of simplified breast cancer intrinsic subtypes: a landmark and two-step approach analyses from the EORTC 10994/BIG 1-00 phase III trial. Ann Oncol 2014; 25:1128-36. [PMID: 24618153 DOI: 10.1093/annonc/mdu118] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Pathological complete response (pCR) following chemotherapy is strongly associated with both breast cancer subtype and long-term survival. Within a phase III neoadjuvant chemotherapy trial, we sought to determine whether the prognostic implications of pCR, TP53 status and treatment arm (taxane versus non-taxane) differed between intrinsic subtypes. PATIENTS AND METHODS Patients were randomized to receive either six cycles of anthracycline-based chemotherapy or three cycles of docetaxel then three cycles of eprirubicin/docetaxel (T-ET). pCR was defined as no evidence of residual invasive cancer (or very few scattered tumour cells) in primary tumour and lymph nodes. We used a simplified intrinsic subtypes classification, as suggested by the 2011 St Gallen consensus. Interactions between pCR, TP53 status, treatment arm and intrinsic subtype on event-free survival (EFS), distant metastasis-free survival (DMFS) and overall survival (OS) were studied using a landmark and a two-step approach multivariate analyses. RESULTS Sufficient data for pCR analyses were available in 1212 (65%) of 1856 patients randomized. pCR occurred in 222 of 1212 (18%) patients: 37 of 496 (7.5%) luminal A, 22 of 147 (15%) luminal B/HER2 negative, 51 of 230 (22%) luminal B/HER2 positive, 43 of 118 (36%) HER2 positive/non-luminal, 69 of 221(31%) triple negative (TN). The prognostic effect of pCR on EFS did not differ between subtypes and was an independent predictor for better EFS [hazard ratio (HR) = 0.40, P < 0.001 in favour of pCR], DMFS (HR = 0.32, P < 0.001) and OS (HR = 0.32, P < 0.001). Chemotherapy arm was an independent predictor only for EFS (HR = 0.73, P = 0.004 in favour of T-ET). The interaction between TP53, intrinsic subtypes and survival outcomes only approached statistical significance for EFS (P = 0.1). CONCLUSIONS pCR is an independent predictor of favourable clinical outcomes in all molecular subtypes in a two-step multivariate analysis. CLINICALTRIALSGOV EORTC 10994/BIG 1-00 Trial registration number NCT00017095.
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Affiliation(s)
- H Bonnefoi
- Department of Medical Oncology, Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U916, Bordeaux, France
| | - S Litière
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels
| | - M Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - G MacGrogan
- Department of Medical Oncology, Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U916, Bordeaux, France
| | | | - E Brain
- Ensemble Hospitalier de L'Institut Curie, Hopital René Huguenin, St-Cloud
| | - T Petit
- Centre Paul Strauss, Strasbourg
| | - P Rouanet
- Centre Val D'Aurelle-Paul Lamarque, Montpellier, France
| | - J Jassem
- Medical University, Gdansk, Poland
| | | | - A Bodmer
- Geneva University Hospital, Geneva Swiss Group for Clinical Cancer Research (SAKK), Bern
| | - K Zaman
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - T Cufer
- Institute of Oncology, Ljubljana University Clinic Golnik, Golnik, Slovenia
| | - M Campone
- Institut de Cancérologie de L'Ouest (ICO), Centre René Gauducheau, Nantes Centre Paul Papin, Angers
| | - E Luporsi
- Centre Alexis Vautrin, Nancy, France
| | - P Malmström
- Department of Clinical Sciences, Lund University, Lund Skåne Department of Oncology, Skåne University Hospital, Lund
| | - G Werutsky
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels
| | - J Bogaerts
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels
| | - J Bergh
- Swedish Breast Cancer Group (SweBCG), Stockholm Department of Oncology, Karolinska Institutet, Radiumhemmet and Karolinska University Hospital, Stockholm, Sweden
| | - D A Cameron
- Cancer Services, Edinburgh University Anglo-Celtic Cooperative Oncology Group (ACCOG), Edinburgh, UK
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Earl HM, Vallier AL, Hiller L, Fenwick N, Young J, Iddawela M, Abraham J, Hughes-Davies L, Gounaris I, McAdam K, Houston S, Hickish T, Skene A, Chan S, Dean S, Ritchie D, Laing R, Harries M, Gallagher C, Wishart G, Dunn J, Provenzano E, Caldas C. Effects of the addition of gemcitabine, and paclitaxel-first sequencing, in neoadjuvant sequential epirubicin, cyclophosphamide, and paclitaxel for women with high-risk early breast cancer (Neo-tAnGo): an open-label, 2×2 factorial randomised phase 3 trial. Lancet Oncol 2014; 15:201-12. [PMID: 24360787 DOI: 10.1016/s1470-2045(13)70554-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anthracyclines and taxanes have been the standard neoadjuvant chemotherapies for breast cancer in the past decade. We aimed to assess safety and efficacy of the addition of gemcitabine to accelerated paclitaxel with epirubicin and cyclophosphamide, and also the effect of sequencing the blocks of epirubicin and cyclophosphamide and paclitaxel (with or without gemcitabine). METHODS In our randomised, open-label, 2×2 factorial phase 3 trial (Neo-tAnGo), we enrolled women (aged >18 years) with newly diagnosed breast cancer (tumour size >20 mm) at 57 centres in the UK. Patients were randomly assigned via a central randomisation procedure to epirubicin and cyclophosphamide then paclitaxel (with or without gemcitabine) or paclitaxel (with or without gemcitabine) then epirubicin and cyclophosphamide. Four cycles of each component were given. The primary endpoint was pathological complete response (pCR), defined as absence of invasive cancer in the breast and axillary lymph nodes. This study is registered with EudraCT (2004-002356-34), ISRCTN (78234870), and ClinicalTrials.gov (NCT00070278). FINDINGS Between Jan 18, 2005, and Sept 28, 2007, we randomly allocated 831 participants; 207 received epirubicin and cyclophosphamide then paclitaxel; 208 were given paclitaxel then epirubicin and cyclophosphamide; 208 had epirubicin and cyclophosphamide followed by paclitaxel and gemcitabine; and 208 received paclitaxel and gemcitabine then epirubicin and cyclophosphamide. 828 patients were eligible for analysis. Median follow-up was 47 months (IQR 37-51). 207 (25%) patients had inflammatory or locally advanced disease, 169 (20%) patients had tumours larger than 50 mm, 413 (50%) patients had clinical involvement of axillary nodes, 276 (33%) patients had oestrogen receptor (ER)-negative disease, and 191 (27%) patients had HER2-positive disease. Addition of gemcitabine did not increase pCR: 70 (17%, 95% CI 14-21) of 404 patients in the epirubicin and cyclophosphamide then paclitaxel group achieved pCR compared with 71 (17%, 14-21) of 408 patients who received additional gemcitabine (p=0·98). Receipt of a taxane before anthracycline was associated with improved pCR: 82 (20%, 95% CI 16-24) of 406 patients who received paclitaxel with or without gemcitabine followed by epirubicin and cyclophosphamide achieved pCR compared with 59 (15%, 11-18) of 406 patients who received epirubicin and cyclophosphamide first (p=0·03). Grade 3 toxicities were reported at expected levels: 173 (21%) of 812 patients who received treatment and had full treatment details had grade 3 neutropenia, 66 (8%) had infection, 41 (5%) had fatigue, 41 (5%) had muscle and joint pains, 37 (5%) had nausea, 36 (4%) had vomiting, 34 (4%) had neuropathy, 23 (3%) had transaminitis, 16 (2%) had acute hypersensitivity, and 20 (2%) had a rash. 86 (11%) patients had grade 4 neutropenia and 3 (<1%) had grade 4 infection. INTERPRETATION Although addition of gemcitabine to paclitaxel and epirubicin and cyclophosphamide chemotherapy does not improve pCR, sequencing chemotherapy so that taxanes are received before anthracyclines could improve pCR in standard neoadjuvant chemotherapy for breast cancer. FUNDING Cancer Research UK, Eli Lilly, Bristol-Myers Squibb.
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Affiliation(s)
- Helena M Earl
- University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Hills Road, Cambridge, UK; National Institute for Health Research, Cambridge Biomedical Research Centre and Cambridge Experimental Cancer Medicine Centre, Hills Road, Cambridge, UK; Department of Oncology, Cambridge Cancer Trials Centre, Addenbrooke's Hospital, Cambridge, UK; Cambridge Breast Unit and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK.
| | - Anne-Laure Vallier
- Department of Oncology, Cambridge Cancer Trials Centre, Addenbrooke's Hospital, Cambridge, UK; Cambridge Breast Unit and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
| | - Louise Hiller
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, UK.
| | - Nicola Fenwick
- Cancer Research UK Clinical Trials Unit, Institute for Cancer Studies, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jennie Young
- Cancer Research UK Clinical Trials Unit, Institute for Cancer Studies, University of Birmingham, Edgbaston, Birmingham, UK
| | | | - Jean Abraham
- National Institute for Health Research, Cambridge Biomedical Research Centre and Cambridge Experimental Cancer Medicine Centre, Hills Road, Cambridge, UK; Department of Oncology, Cambridge Cancer Trials Centre, Addenbrooke's Hospital, Cambridge, UK; Cambridge Breast Unit and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK; CancerResearch UK Cambridge Institute, Cambridge, UK
| | - Luke Hughes-Davies
- Department of Oncology, Cambridge Cancer Trials Centre, Addenbrooke's Hospital, Cambridge, UK; Cambridge Breast Unit and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
| | | | - Karen McAdam
- Cambridge Breast Unit and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK; Peterborough and Stamford Hospitals NHS Foundation Trust and Cambridge University Hospital NHS Foundation Trust, UK
| | - Stephen Houston
- Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, UK
| | - Tamas Hickish
- Royal Bournemouth Hospital, Castle Lane East, Bournemouth, UK
| | - Anthony Skene
- Department of Surgery, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, UK
| | - Stephen Chan
- Nottingham City Hospital, Hucknall Road, Nottingham, UK
| | - Susan Dean
- Dorset Cancer Centre, Poole Hospital NHS Trust, Poole, UK
| | - Diana Ritchie
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, UK
| | - Robert Laing
- Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, UK
| | - Mark Harries
- Breast Oncology Unit, Thomas Guy House, Guys Hospital, St Thomas Street, London, UK
| | - Christopher Gallagher
- Department of Medical Oncology, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Gordon Wishart
- Cambridge Breast Unit and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
| | - Janet Dunn
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, UK
| | - Elena Provenzano
- National Institute for Health Research, Cambridge Biomedical Research Centre and Cambridge Experimental Cancer Medicine Centre, Hills Road, Cambridge, UK; Department of Oncology, Cambridge Cancer Trials Centre, Addenbrooke's Hospital, Cambridge, UK; Cambridge Breast Unit and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
| | - Carlos Caldas
- University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Hills Road, Cambridge, UK; National Institute for Health Research, Cambridge Biomedical Research Centre and Cambridge Experimental Cancer Medicine Centre, Hills Road, Cambridge, UK; Department of Oncology, Cambridge Cancer Trials Centre, Addenbrooke's Hospital, Cambridge, UK; Cambridge Breast Unit and Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK; CancerResearch UK Cambridge Institute, Cambridge, UK
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