|
1
|
Cui M, Fu J, Li Q. Comparison of neoadjuvant single-agent treatment and dual-HER2 blockade for breast-conserving surgery conversion in HER2-positive breast cancer: a meta-analysis. BMC Cancer 2024; 24:1293. [PMID: 39425072 PMCID: PMC11490152 DOI: 10.1186/s12885-024-13052-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 10/10/2024] [Indexed: 10/21/2024] Open
Abstract
BACKGROUND Neoadjuvant targeted therapy has shown that improve pathologic complete response and facilitate breast-conserving surgery, but the difference between single-agent treatment or dual-HER2 blockade to the conversion of breast-conserving surgery has not been well described. METHODS Via the systematic literature search of PubMed, Web of Science and Cochrane Library databases, 5 eligible studies used to perform this meta-analysis, which was carried out using RevMan version 5.4. RESULTS A total of 1306 patients from five randomized controlled trials were included in the analysis, revealing a significant increase in the conversion rate to breast-conserving surgery with neoadjuvant targeted therapy (OR 0.30, 95% CI 0.15-0.57; p = 0.0003). The odds ratio (OR) for single-agent treatment compared to dual-HER2 blockade was 1.04 (95% CI 0.73-1.48; p = 0.82). For pathological complete response (pCR), the OR for single-HER2 blockade versus dual-HER2 blockade was 0.43 (95% CI 0.34-0.55; p = 0.01), and for clinical response, it was 0.81 (95% CI 0.59-1.10; p = 0.17). The OR for serious adverse events between single-HER2 and dual-HER2 blockade was 0.72 (95% CI 0.55-0.95; p = 0.02). The risk ratio (RR) for pCR and the shift from mastectomy to BCS was 1.16 (95% CI 0.78-1.72; p = 0.47), while for clinical response and the shift from mastectomy to BCS, it was 2.40 (95% CI 1.44-4.01; p = 0.0008). CONCLUSION Neoadjuvant targeted treatment obviously promote the actual implementation rate of breast-conserving surgery, nevertheless, there was no statistically significant increase in single-agent treatment versus dual-HER2 blockade.
Collapse
Affiliation(s)
- Manlu Cui
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Juan Fu
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Qiuyun Li
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, 530021, China.
| |
Collapse
|
|
2
|
Atzori G, Gipponi M, Cornacchia C, Diaz R, Sparavigna M, Gallo M, Ruelle T, Murelli F, Franchelli S, Depaoli F, Friedman D, Fregatti P. " No Ink on Tumor" in Breast-Conserving Surgery after Neoadjuvant Chemotherapy. J Pers Med 2022; 12:jpm12071031. [PMID: 35887526 PMCID: PMC9320436 DOI: 10.3390/jpm12071031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background/Aim: Patients with Stage I-II breast cancer undergoing breast-conserving surgery after neoadjuvant chemotherapy (BCS-NAC) were retrospectively assessed in order to evaluate the extent of a safe excision margin. Materials and Methods: Between 2003 and 2020, 151 patients underwent risk-adapted BCS-NAC; margin involvement was always assessed at definitive histology. Patients with complete pathological response (pCR) were classified as the RX group, whereas those with residual disease and negative margins were stratified as R0 < 1 mm (margin < 1 mm) and R0 > 1 mm (margin > 1 mm). Results: Totals of 29 (19.2%), 64 (42.4%), and 58 patients (38.4%) were included in the R0 < 1 mm, R0 > 1 mm, and RX groups, respectively, and 2 patients with margin involvement had a mastectomy. Ten instances of local recurrence (6.6%) occurred, with no statistically significant difference in local recurrence-free survival (LRFS) between the three groups. A statistically significant advantage of disease-free survival (p = 0.002) and overall survival (p = 0.010) was observed in patients with pCR. Conclusions: BCS-NAC was increased, especially in HER-2-positive and triple-negative tumors; risk-adapted BCS should be preferably pursued to highlight the cosmetic benefit of NAC. The similar rate of LRFS in the three groups of patients suggests a shift toward the “no ink on tumor” paradigm for patients undergoing BCS-NAC.
Collapse
Affiliation(s)
- Giulia Atzori
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
| | - Marco Gipponi
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
- Correspondence: ; Tel.: +30-010-5558805
| | - Chiara Cornacchia
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
| | - Raquel Diaz
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy; (R.D.); (T.R.)
| | - Marco Sparavigna
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
| | - Maurizio Gallo
- Department of Internal Medicine (Di.M.I.), University of Genoa, 16132 Genoa, Italy;
| | - Tommaso Ruelle
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy; (R.D.); (T.R.)
| | - Federica Murelli
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy; (R.D.); (T.R.)
| | - Simonetta Franchelli
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
| | - Francesca Depaoli
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
| | - Daniele Friedman
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy; (R.D.); (T.R.)
| | - Piero Fregatti
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy; (G.A.); (C.C.); (M.S.); (F.M.); (S.F.); (F.D.); (D.F.); (P.F.)
- Department Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy; (R.D.); (T.R.)
| |
Collapse
|
|
3
|
Montagna G, Mamtani A, Knezevic A, Brogi E, Barrio AV, Morrow M. Selecting Node-Positive Patients for Axillary Downstaging with Neoadjuvant Chemotherapy. Ann Surg Oncol 2020; 27:4515-4522. [PMID: 32488513 DOI: 10.1245/s10434-020-08650-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Axillary lymph node dissection (ALND) can be avoided in node-positive patients who receive neoadjuvant chemotherapy (NAC) if three or more negative sentinel lymph nodes (SLNs) are retrieved. We evaluate how often node-positive patients avoid ALND with NAC, and identify predictors of identification of three or more SLNs and of nodal pathological complete response (pCR). METHODS From November 2013 to July 2019, all patients with cT1-3, biopsy-proven N1 tumors who converted to cN0 after NAC received SLN biopsy (SLNB) with dual mapping and were identified from a prospectively maintained database. RESULTS 630 consecutive N1 patients were eligible for axillary downstaging with NAC; 573 (91%) converted to cN0 and had SLNB, and 531 patients (93%) had three or more SLNs identified. Lymphovascular invasion (LVI; odds ratio [OR] 0.46, 95% confidence interval [CI] 0.24-0.87; p = 0.02) and increasing body mass index (BMI; OR 0.77, 95% CI 0.62-0.96 per 5-unit increase; p = 0.02) were significantly associated with failure to identify three or more SLNs. 255/573 (46%) patients achieved nodal pCR; 237 (41%) had adequate mapping. Factors associated with ALND avoidance included high grade (OR 2.51, 95% CI 1.6-3.94, p = 0.001) and receptor status (HR+/HER2- [referent]: OR 1.99, 95% CI 1.15-3.46 [p = 0.01] for HR-/HER2-, OR 3.93, 95% CI 2.40-6.44 [p < 0.001] for HR+/HER2+, and OR 8.24, 95% CI 4.16-16.3 [p < 0.001] for HR-/HER2+). LVI was associated with a lower likelihood of avoiding ALND (OR 0.28, 95% CI 0.18-0.43; p < 0.001). CONCLUSIONS ALND was avoided in 41% of cN1 patients after NAC. Increased BMI and LVI were associated with lower retrieval rates of three or more SLNs. ALND avoidance rates varied with receptor status, grade, and LVI. These factors help select patients most likely to avoid ALND.
Collapse
Affiliation(s)
- Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anita Mamtani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Knezevic
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea V Barrio
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
|
5
|
Meta-analysis of neoadjuvant therapy and its impact in facilitating breast conservation in operable breast cancer. Br J Surg 2018; 105:469-481. [DOI: 10.1002/bjs.10807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/29/2017] [Accepted: 11/27/2017] [Indexed: 01/11/2023]
Abstract
Abstract
Background
Neoadjuvant therapy (NAT) for operable breast cancer may facilitate more breast-conserving surgery (BCS). It seems, however, that this benefit is not being realized fully.
Methods
A systematic review of the literature was performed. RCTs were included. The criteria for inclusion were: documentation of surgical assessment before and after NAT, surgery performed (BCS or mastectomy), and clinical and pathological responses.
Results
A total of 1452 patients from seven RCTs met the inclusion criteria. After NAT, the feasibility of BCS increased from 43·3 to 60·4 per cent (P < 0·001), but BCS was performed in only 51·8 per cent (P = 0·04). Only 31 per cent of patients who became eligible for BCS (assessed on clinical response) underwent BCS (pooled rate ratio 0·31, 95 per cent c.i. 0·22 to 0·44; P < 0·001). Of the mastectomy candidates who achieved a pathological complete response after NAT, only 41 per cent underwent BCS (pooled rate ratio 0·41, 0·23 to 0·74; P = 0·003). The main factors that influenced the decision not to shift to BCS, even though it was feasible, were clinical assessment before NAT, multicentricity and tumour size at presentation.
Conclusion
Breast surgery performed after NAT does not reflect tumour response, resulting in potentially unnecessary radical surgery, especially mastectomy. The barriers to maximizing the surgical benefits of NAT need to be better understood and explored.
Collapse
|