Pathologic Complete Response of HER-2 Neu-Positive Invasive Ductal Carcinoma and Ductal CarcinomaIn Situfollowing Neoadjuvant Chemotherapy plus Trastuzumab: A Case Report and Review of Literature

e11582 Background: Serum Her-2/neu has been known as molecular surrogating marker of predicting treatment response in Her-2 positive breast cancer. We compare the change of serum Her-2/neu during neoadjuvant chemotherapy between trastuzumab(H) and anthyracyline(A) based treatment. Methods: All breast cancers were tested by immunohistochemical stain and FISH for Her-2/neu before treatment. Serum Her-2/neu was twice measured by Chemiluminescence immunoassay(ADVIA centaurTMsystem) before neoadjuvant chemotherapy and before operation. The cutoff value was 10.2 mg/ml according to previous study. Pathologic complete response (pCR) was considered as no residual tumor or remnant ductal carcinoma in situ, partial response (PR) was less than 50% decrease in maximal diameter in pathologic tumor size. Results: Serum Her-2/neu of trastuzumab group was more decreased than of anthyracyline group (H; 12.9 ± 14.5 ng/mL vs. A; 2.2 ± 1.2 ng/mL, p=0.024). In trastuzumab group, pCR was relatively correlated with decrease of serum Her-2/neu (PR: 0.8 ± 0.84 ng/ml vs. pCR: 21.1 ± 13.2 ng/ml, p=0.08). Conclusions: A decrease in serum Her-2/neu levels during treatment was associated with pathologic response in patients receiving neoadjuvant chemotherapy, particularly, trastuzumab-based regimen. Serum Her-2/neu levels may serve to monitoring neoadjuvant therapy in Her-2/neu positive breast cancer. No significant financial relationships to disclose.

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Association of ERCC1 (rs11615) and DNASE2B (rs3738573) polymorphisms with pathologic complete response to neoadjuvant chemotherapy for HER2-overexpressing breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.536 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 536-536

Author(s):

Agnes Ducoulombier ◽

Aurelie Dumont ◽

Emmanuelle Tresch ◽

Jinying Chen ◽

Diane Pannier ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Hormone Receptor ◽

Target Genes ◽

Ductal Carcinoma ◽

Pathologic Complete Response ◽

Complete Response ◽

Her2 Overexpression ◽

Hormonal Status ◽

Her 2

536 Background: Pathological complete response (pCR) is the main prognostic factor after preoperative chemotherapy. Predictive factors of pCR are mainly histological type, hormonal status, HER2 overexpression. Single nucleotide polymorphisms (SNP) in genes encoding drug transporters, drug metabolizing enzymes and target genes can affect drug efficacy and may explain therapeutic failures. The aim of the study was to identify SNPs associated with pCR in breast cancer (BC) patients (PTS) with HER-2 overexpression and treated with sequential neoadjuvant chemotherapy. Methods: Among PTS treated with NCT and included between 2007 and 2012, 46 PTS had HER-2 overexpressing BC, mostly ductal carcinoma (91.3%), greater than or equal to T2 (97.7%) and N1 (65.2%).91.3% of PTS received 3 FEC 100 - 3 Taxotere and 18 cycles of trastuzumab (3-18). Genotyping of 46 SNPs was performed on germline DNA using real time PCR. pCR was correlated with clinicopathologic features and genotypes using logistic regression. Results: pCR was evaluable for 45 PTS according to Sataloff criteria: pCR rate was 40% (95% CI 25.7-55.7%) and was significantly associated with hormonal status: 60.9% in negative hormone receptor tumors and 18.2% in positive hormone receptor tumors (p = 0.004). Four SNPs were significantly associated with pCR. All patients homozygotes CC for ERCC1-rs11615 respond to NCT (p=0.024). The response rate was higher for patients homozygotes TT for NQO2-rs1143684 (59.1%; p=0.018), PTS carrying one or two C allele for DNASE2B-rs3738573 (50%; p=0.025) and PTS carrying one or two C allele for MDR1-rs1045642(51.5%; p=0.012). Conclusions: In this pilot study 4 SNPs were significantly associated with pCR and may be useful to predict response to NCT (Anthracyclines/Taxanes/Trastuzumab regimen) for HER-2 overexpressing breast tumors. Moreover, DNASE2B-rs3738573 and ERCC1-rs11615, two polymorphisms located in genes involved in DNA reparation, have never been described as predictive markers for BC neoadjuvant chemotherapy. (The first 3 authors contributed equally to this work.)

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Image-guided vacuum-assisted biopsy to assess pathologic complete response in breast cancer patients with exceptional response to neoadjuvant chemotherapy.

Journal of Global Oncology ◽

10.1200/jgo.2019.5.suppl.39 ◽

2019 ◽

Vol 5 (suppl) ◽

pp. 39-39

Author(s):

Victoria Teoh ◽

Fiona MacNeill ◽

Nicola Roche ◽

Gerald Gui ◽

Romney Pope ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Invasive Ductal Carcinoma ◽

Ductal Carcinoma ◽

Residual Disease ◽

False Negative ◽

Pathologic Complete Response ◽

Complete Response ◽

Her2 Positive ◽

Image Guided

39 Background: Image-guided vacuum-assisted biopsy (VAB) is increasingly used after completion of neoadjuvant chemotherapy (NAC) to assess residual disease in the breast, facilitate risk-adaptive surgery and potentially identify exceptional responders who may not require surgical intervention. The aim of this analysis was to investigate the diagnostic performance of a standardized post-NAC VAB protocol, developed following retrospective analysis of institutional data (1). Methods: Prospective cohort study of patients with HER2 positive and triple negative (TN) invasive ductal carcinoma, treated with NAC, who had partial/complete imaging response and underwent post-NAC VAB to aid surgical planning between 02/2018 and 06/2019. The aim of VAB was to sample the site of residual imaging abnormality (breast residuum <2cm) previously marked by clip insertion. Pathologic complete response (pCR) was defined as no residual disease in the breast (ypT0). Diagnostic accuracy of VAB was calculated using final surgical pathology as the reference standard. Simple descriptive statistics were performed. Results: 26 eligible patients underwent post-NAC VAB. This was representative in 23 cases. The overall pCR rate was 46.2% (42.1% for HER2 positive, 57.1% for TN phenotypes). The post-NAC VAB false negative rate (FNR) was 9.1% (95% CI: 0-26.1) and the negative predictive value (NPV) was 90.91% (95% CI: 60.27-98.51) with an overall accuracy of 86.96% (95% CI: 66.41-97.22). Conclusions: This data suggests that post-NAC VAB may reliably predict pCR in patients with HER2 positive and TN invasive ductal carcinoma with good response to NAC. Further technical refinements in VAB technique, standardization in patient selection and prospective trials are warranted to further explore the role of post-NAC VAB in supporting minimal or no surgery trials. References 1. Tasoulis MK, Roche N, Rusby JE, Pope R, Allen S, Downey K, Nerurkar A, Osin P, Wilson R, MacNeill F. Post neoadjuvant chemotherapy vacuum assisted biopsy in breast cancer: Can it determine pathologic complete response before surgery? J Clin Oncol 2018;36 (Supplement): abstr 567.

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Molecular Types and Neoadjuvant Chemotherapy in Patients with Breast Cancer- While Molecular Shifting is More Common in Luminal a Tumors, The Pathologic Complete Response is Most Frequently Observed in Her-2 Like Tumors

Asian Pacific Journal of Cancer Prevention ◽

10.7314/apjcp.2014.15.21.9379 ◽

2014 ◽

Vol 15 (21) ◽

pp. 9379-9383 ◽

Cited By ~ 4

Author(s):

Derya Kivrak Salim ◽

Hasan Mutlu ◽

Melek Karakurt Eryilmaz ◽

Fatma Yalcin Musri ◽

Deniz Tural ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Pathologic Complete Response ◽

Complete Response ◽

Luminal A ◽

Her 2

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Pathologic Response Rates for Breast Cancer Stages as a Predictor of Outcomes in Patients Receiving Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery

10.21203/rs.3.rs-111293/v1 ◽

2020 ◽

Author(s):

Chang-Yun Lu ◽

Ho-Min Chen ◽

Szu-Yuan Wu

Keyword(s):

Neoadjuvant Chemotherapy ◽

Cox Regression ◽

Ductal Carcinoma ◽

Pathologic Complete Response ◽

Response Rates ◽

Complete Response ◽

Breast Conserving Surgery ◽

Pathologic Response ◽

Cox Regression Analysis ◽

All Cause Mortality

Abstract PURPOSE: To determine easy-to-use predictors of overall survival (OS), locoregional recurrence (LRR), and distant metastasis (DM) in patients with breast invasive ductal carcinoma (IDC) receiving neoadjuvant chemotherapy (NACT) followed by breast-conserving surgery (BCS), we obtained pathologic response rates (PRRs) for combined primary and nodal diseases (American Joint Committee on Cancer [AJCC] stages) from clinical and pathologic reports, and we used these as predictors.PATIENTS AND METHODS: We enrolled patients with IDC who had received NACT followed by BCS. Cox regression analysis was used to calculate hazard ratios (HRs) and confidence intervals (CIs) for the patients’ PRRs; other independent predictors were controlled for or stratified in the analysis.RESULTS: We analyzed 1047 patients with IDC (611, 260, and 176 patients in clinical stages IIB, IIIA, and IIIB-C, respectively) receiving NACT and BCS. After multivariate Cox regression analyses, the adjusted HRs (aHRs; 95% CI) in patients with pathologic complete response (ypT0N0) were 0.26 (0.13–0.56), 0.36 (0.15–0.85), and 0.15 (0.08–0.31) for all-cause mortality, LRR, and DM, respectively. The aHRs (95% CI) in patients with downstaging of AJCC stages were 0.55 (0.35–0.89), 0.91 (0.62–0.96), and 0.63 (0.43–0.91) for all-cause mortality, LRR, and DM, respectively. The aHRs (95% CI) in patients with upstaging of AJCC stages were 1.77 (1.06–2.24), 1.08 (1.03–1.82), and 1.19 (1.07–2.01) for all-cause mortality, LRR, and DM, respectively.CONCLUSION: The impacts of AJCC-stage PRRs are useful predictive tools and strong predictors for OS, LRR, and DM in patients with breast IDC receiving NACT followed by BCS.

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Pathologic Response Rates for Breast Cancer Stages as a Predictor of Outcomes in Patients Receiving Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery

10.21203/rs.3.rs-97674/v1 ◽

2020 ◽

Author(s):

jiaqiang Zhang ◽

Chang-Yun Lu ◽

Ho-Min Chen ◽

Szu-Yuan Wu

Keyword(s):

Neoadjuvant Chemotherapy ◽

Cox Regression ◽

Ductal Carcinoma ◽

Pathologic Complete Response ◽

Response Rates ◽

Complete Response ◽

Breast Conserving Surgery ◽

Pathologic Response ◽

Cox Regression Analysis ◽

All Cause Mortality

Abstract PURPOSE: To determine easy-to-use predictors of overall survival (OS), locoregional recurrence (LRR), and distant metastasis (DM) in patients with breast invasive ductal carcinoma (IDC) receiving neoadjuvant chemotherapy (NACT) followed by breast-conserving surgery (BCS), we obtained pathologic response rates (PRRs) for combined primary and nodal diseases (American Joint Committee on Cancer [AJCC] stages) from clinical and pathologic reports, and we used these as predictors.PATIENTS AND METHODS: We enrolled patients with IDC who had received NACT followed by BCS. Cox regression analysis was used to calculate hazard ratios (HRs) and confidence intervals (CIs) for the patients’ PRRs; other independent predictors were controlled for or stratified in the analysis.RESULTS: We analyzed 1047 patients with IDC (611, 260, and 176 patients in clinical stages IIB, IIIA, and IIIB-C, respectively) receiving NACT and BCS. After multivariate Cox regression analyses, the adjusted HRs (aHRs; 95% CI) in patients with pathologic complete response (ypT0N0) were 0.26 (0.13–0.56), 0.36 (0.15–0.85), and 0.15 (0.08–0.31) for all-cause mortality, LRR, and DM, respectively. The aHRs (95% CI) in patients with downstaging of AJCC stages were 0.55 (0.35–0.89), 0.91 (0.62–0.96), and 0.63 (0.43–0.91) for all-cause mortality, LRR, and DM, respectively. The aHRs (95% CI) in patients with upstaging of AJCC stages were 1.77 (1.06–2.24), 1.08 (1.03–1.82), and 1.19 (1.07–2.01) for all-cause mortality, LRR, and DM, respectively.CONCLUSION: The impacts of AJCC-stage PRRs are useful predictive tools and strong predictors for OS, LRR, and DM in patients with breast IDC receiving NACT followed by BCS.

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Pathological Complete Response following Neoadjuvant Chemotherapy in Invasive Ductal Carcinoma with Mammary Paget’s Disease: A Case Report

Case Reports in Oncology ◽

10.1159/000516762 ◽

2021 ◽

pp. 1242-1247

Author(s):

Wataru Goto ◽

Shinichiro Kashiwagi ◽

Yuko Kawano ◽

Asuka Komoda ◽

Sae Ishihara ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Invasive Ductal Carcinoma ◽

Ductal Carcinoma ◽

Histopathological Examination ◽

Paget’S Disease ◽

Complete Response ◽

Breast Conserving Surgery ◽

Punch Biopsy ◽

Paget's Disease ◽

Mammary Paget’S Disease

Mammary Paget’s disease is a rare malignancy. Mastectomy or breast-conserving surgery has been considered as the standard treatment, while there have been few reports of neoadjuvant chemotherapy (NAC). A 53-year-old woman with erythema and skin ulceration of the left breast was admitted to our institution. Breast examinations revealed left invasive ductal carcinoma (cT1bN0M0, cStage I), and a punch biopsy of the left mammary erythema indicated Paget’s disease (cTisN0M0, cStage0). The patient received NAC because of multiple lesions. Consequently, the breast tumor clinically disappeared, and the erythema improved. These outcomes made it easier to perform surgery (left mastectomy and sentinel node biopsy). Histopathological examination revealed no residual cancer cells in either the mammary gland or breast skin, and no metastasis was found in the sentinel lymph node. Therefore, NAC may be a useful treatment for mammary Paget’s disease.

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Effect of clinical and biological factors on pathologic complete response (pCR) after neoadjuvant chemotherapy for patients (pts) with early-stage breast cancer (BC).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e11551 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e11551-e11551

Author(s):

Pierre Kouchner ◽

Jean-Philippe Spano ◽

Eugenie Guillot ◽

Emmanuel Touboul ◽

Florence Renouvel ◽

...

Keyword(s):

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Neoadjuvant Therapy ◽

Mitotic Index ◽

Univariate Analysis ◽

Pathologic Complete Response ◽

Complete Response ◽

Her2 Overexpression ◽

Significant Prognostic Factor ◽

Her 2

e11551 Background: To evaluate predictive factors that impact pathologic complete response (pCR) after neoadjuvant chemotherapy (NC) for BC pts. The identification of such factors may improve pt selection for neoadjuvant therapy to maximize the likelihood of breast conservation surgery (BCS) Methods: A total of 279 pts treated with NC (anthracyclines and/or taxanes based chemotherapy) for BC were analyzed. Pathologic response was evaluated using Sataloff classification. Student’s test and Fisher’s test were used for statistical analysis; OS and DFS rates were estimated by Kaplan-Meier analysis and log rank test for outcome. Results: According to the TNM classification, 87.4% of pts had T2 /T3 tumors, and 45.9% of pts had a lymph node involvement before NC. HER-2 over expression was found in 23.5 % and 18.6 % of pts had triple negative tumors. Forty three (43%) of pts achieved a clinical complete response. BCS was performed in 44.8%. pCR was 26.4% in the breast primary tumor and 32.8% in the axillary nodes. Univariate analysis showed that the following variables at diagnosis were correlated with a pCR: T2 vs T3/T4 (P<0.001), ductal invasive carcinoma (P=0.001), high grade (p<0.007), high mitotic index (P<0.001), estrogen receptor (ER) negative tumors (p=0.001), progesterone receptor negative tumors (p=0.001), chemotherapy with taxanes (p=0.0026), trastuzumab therapy (p<0.001) and the number of chemotherapy cycles (p=0.002). In multivariate analysis, ER negative, high mitotic index and HER-2 overexpression were significantly associated with a pCR (P<0.01). Lymph node pCR was a significant prognostic factor with 5 year RFS and DFS (respectively p<0.001 and p=0.016). At a median follow-up of 53.4 months, OS and DFS at 5 years were 86.1% and 24.2% respectively. Conclusions: Our data support the hypothesis that ER negative, high mitotic index and HER2 overexpression significantly predicted pCR in pts receiving neoadjuvant therapy for early BC. These results may suggest using such factors before deciding neoadjuvant chemotherapy in order to increase eligibility for BCS.

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