Cancer’s Response to Chemotherapy Before Surgery May Help Predict Risk of Recurrence

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Treatments given to weaken and destroy breast cancer before surgery are called neoadjuvant treatments. Most neoadjuvant treatments involve one or more chemotherapy medicines. Targeted therapy medicines, hormonal therapy, or radiation therapy also are sometimes used as neoadjuvant treatments.

Treatment before surgery isn’t routinely used to treat early-stage breast cancer, but may be used if the cancer is large or aggressive. When neoadjuvant treatment dramatically shrinks a cancer, lumpectomy instead of mastectomy may be an option for some women.

While neoadjuvant treatments can shrink a breast cancer before surgery, little research has been done on how neoadjuvant chemotherapy affects the risk of the cancer coming back in the breast area (called locoregional recurrence).

In this study, researchers analyzed information from 12 clinical trials on neoadjuvant chemotherapy that involved nearly 12,000 people. The researchers wanted to know if there were certain factors, such as the type of breast cancer or how the cancer responded to neoadjuvant chemotherapy, that would help predict the risk of recurrence and also help doctors better understand who would benefit from radiation therapy after neoadjuvant chemotherapy and surgery.

The study was presented on Sept. 4, 2014 at the 2014 American Society of Clinical Oncology Breast Cancer Symposium. Read the abstract of “Locoregional recurrence (LRR) after neoadjuvant chemotherapy (NAC): Pooled-analysis results from the collaborative trials in neoadjuvant breast cancer (CTNeoBC).”

Most of the women in the studies analyzed were followed for about 5 years:

  • 61% of the women were diagnosed with cancers that were larger than 2 cm but smaller than 5 cm
  • 47% of the women had positive lymph nodes

Looking at the 5,252 women who had received neoadjuvant chemotherapy, the researchers found that 8.8% of the women had the cancer come back in the breast area. The researchers then looked at recurrence rates in specific groups, including:

  • Type of surgery:
    • 7.8% of women who had lumpectomy had a recurrence
    • 10.4% of women who had mastectomy had a recurrence
  • Type of breast cancer:
    • 4.2% of women diagnosed with grade 1-2, hormone-receptor-positive, HER2-negative disease had a recurrence
    • 9.2% of women diagnosed with grade 3, hormone-receptor-positive, HER2-negative disease had a recurrence
    • 14.8% of women diagnosed with hormone-receptor-negative, HER2-positive disease had a recurrence
    • 9.7% of women diagnosed with hormone-receptor-positive, HER2-positive disease had a recurrence
    • 12.2% of women diagnosed with hormone-receptor-negative, HER2-negative disease (triple-negative breast cancer) had a recurrence
  • Pathologic complete response: One way doctors judge the effectiveness of neoadjuvant chemotherapy is to look at the tissue removed during surgery to see if any active cancer cells are present. If no active cancer cells are present, doctors call it a “pathologic complete response.”
    • 5.5% of women who had a pathologic complete response had a recurrence
    • 7.1% of women who didn’t have a pathologic complete response had a recurrence
    • 6.0% of women who had a pathologic complete response and lumpectomy had a recurrence
    • 6.3% of women who didn’t have a pathologic complete response and lumpectomy had a recurrence
    • 3.8% of women who had a pathologic complete response and mastectomy had a recurrence
    • 8.1% of women who didn’t have a pathologic complete response and mastectomy had a recurrence

While overall recurrence rates were low, the researchers did find that certain factors were linked to a higher risk of recurrence.

For women who had lumpectomy:

  • being younger than 50
  • not having a pathologic complete response
  • cancer characteristics (hormone-receptor-negative, HER2-positive and hormone-receptor-negative, HER2-negative)

were linked to a higher risk of recurrence.

For women who had mastectomy:

  • not having a pathologic complete response
  • cancer characteristics (hormone-receptor-negative, HER2-positive and hormone-receptor-negative, HER2-negative)

were linked to a higher risk of recurrence.

The researchers said knowing which women may be at higher risk of recurrence after neoadjuvant chemotherapy may help doctors better decide who should be prescribed radiation therapy after surgery to reduce that risk.

“Our findings have clinical implications relative to further tailoring the use of adjuvant radiation therapy after neoadjuvant chemotherapy and support the conduct of ongoing clinical trials attempting to tailor locoregional therapy in this setting,” said Eleftherios Mamounas, M.D., of the University of Florida Cancer Center who led the study.

If you’ve been diagnosed with breast cancer and your doctor has recommended treatment before surgery, you may want to ask your doctor about this study. Ask your doctor how your risk of locoregional recurrence will be assessed and how that information might affect any treatments after surgery. Accurate information about the cancer and its risk of recurrence is essential to developing a treatment plan that makes the most sense for you.



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