Abstract
Background
The benefit of neoadjuvant chemotherapy (NAC) in patients with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2−) breast cancers and in invasive lobular carcinoma (ILC) is uncertain due to the low rates of pathologic complete response (pCR).
Objective
The aim of this study was to determine if pathologic features can identify subsets likely to benefit from NAC.
Methods
Patients with stage I–III ER+, HER2− breast cancer receiving NAC were retrospectively reviewed. Endpoints were downstaging to breast-conserving surgery (BCS) and nodal pCR after NAC. Patients were grouped by progesterone receptor (PR) status and grade/differentiation (high grade or poor [HP] vs. non-HP).
Results
From 2007 to 2016, 402 ER+/HER2− cancers in patients receiving NAC were identified. Median age was 50 years, 98% were clinical stage II–III, and 75% were cN+. Overall pCR rate was 5%; breast pCR in 7% and nodal pCR in 15% of cN+ patients (p < 0.0001). Patients with ILC initially ineligible for BCS (n = 56) were less likely to downstage than those with invasive ductal carcinoma (IDC; n = 183, 16 vs. 48%, p ≤ 0.0001), with a similar trend in the axilla (p = 0.086). The rates of BCS eligibility after NAC were highest in PR−/HP patients (62%) and lowest in PR+/non-HP patients (29%) [p = 0.005]. In the axilla, nodal pCR among cN+ patients (n = 301) ranged from 0 to 35% (p < 0.0001) within these groups, and was most frequent in PR−/HP patients.
Conclusions
ER+/HER2− patients most likely to benefit from NAC are those with PR− and HP tumors. Patients with ILC are unlikely to downstage in the breast or axilla compared with IDC. The use of these criteria can assist in defining the initial treatment approach.
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Acknowledgment
The preparation of this manuscript was funded in part by National Institutes of Health/National Cancer Institute (NIH/NCI) Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center. This study was supported by Judy Guitelman, Dan Epstein, and the Dan J. Epstein Family Foundation, and was presented in part in podium format at the Society of Surgical Oncology 2017 Annual Cancer Symposium, Seattle, WA, USA, 15–18 March 2017.
Disclosure
Oriana A. Petruolo, Melissa Pilewskie, Sujata Patil, Andrea V. Barrio, Michelle Stempel, Hannah Y. Wen, and Monica Morrow have no conflicts of interest to report.
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Petruolo, O.A., Pilewskie, M., Patil, S. et al. Standard Pathologic Features Can Be Used to Identify a Subset of Estrogen Receptor-Positive, HER2 Negative Patients Likely to Benefit from Neoadjuvant Chemotherapy. Ann Surg Oncol 24, 2556–2562 (2017). https://doi.org/10.1245/s10434-017-5898-z
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DOI: https://doi.org/10.1245/s10434-017-5898-z