Abstract
PurposeNeoadjuvant chemotherapy is the standard front-line treatment modality in locally advanced breast cancer. Achieving pathological complete response (pCR) is a significant prognostic factor for prolonged disease-free and overall survival. Insulin resistance is defined as a pathological condition in which insulin effect is impaired in peripheral target tissues such as the skeletal muscle, liver, and adipose tissue. The relationship between breast cancer and insulin resistance is controversial. In this study, our aim is to evaluate the role of insulin resistance, body mass index (BMI), metabolic syndrome, and inflammation markers to predict complete response in breast cancer patients who underwent neoadjuvant treatment.MethodsData from 55 locally advanced non-diabetic breast cancer patients, treated with neoadjuvant chemotherapy between 2015 and 2017, were retrospectively evaluated. Homeostatic model assessment, IR = insulin resistance (HOMA-IR) was calculated by using the obtained insulin and fasting blood glucose values before neoadjuvant chemotherapy (fasting insulin × fasting glucose/405). We considered a cut-off of 2.5 for insulin resistance. The systemic inflammatory index (SII), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were calculated.ResultsTwenty-five patients had no insulin resistance. The most common pathologic subtype (56%) was hormone receptor (HR) positive and human epidermal growth factor receptor-2 (Her-2)-negative invasive ductal carcinoma. Sixteen (29%) patients had a pathological complete response (pCR). We found that the probability of pCR in patients with insulin resistance was 4.7 times lower than that in patients without insulin resistance [OR: 4.7 (95%CI 1.7–17.2), p = 0.01].ConclusionOur results revealed that insulin resistance may have a negative effect on pathological complete response (pCR) following neoadjuvant therapy particularly with hormone-positive and Her-2-negative cases of non-diabetic breast cancer.
Highlights
Worldwide, breast cancer is the most commonly diagnosed cancer and is the second most common cause of cancer-related death in women [1]
We found that the probability of pathological complete response (pCR) in patients with insulin resistance was 4.7 times lower than that in patients without insulin resistance [Odds ratio (OR): 4.7 (95%confidence intervals (CI) 1.7–17.2), p = 0.01]
Our results revealed that insulin resistance may have a negative effect on pathological complete response following neoadjuvant therapy with hormone-positive and human epidermal growth factor receptor-2 (Her-2)-negative cases of nondiabetic breast cancer
Summary
Breast cancer is the most commonly diagnosed cancer and is the second most common cause of cancer-related death in women [1]. Current-tailored treatment of breast cancer is discussed in multidisciplinary teams which involved surgical oncology, radiation oncology, and medical oncology for each patient, and this approach was reported to increase breast cancer survival rates [2]. Neoadjuvant chemotherapy (NAC) has become a standard treatment approach in breast cancer patients with locally advanced disease [3]. Pathologic complete response (pCR) after NAC is a significant surrogate prognostic marker for both disease-free and overall survival in breast cancer [4, 5]. Expected pCR with NAC is approximately 30% in HER2-positive and 30 to 50% in triple-negative histology, whilst it is less than 10% in hormone-positive and HER2-negative breast cancer patients [6,7,8]
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