Outcome after neoadjuvant chemotherapy in Asian breast cancer patients.

Li Min Lim ,Yia Swam Tan,Geok Hoon Lim,Fuh Yong Wong,Evan Woo,Nirmala Bhoo‐Pathy,Cheng Har Yip,Kong Wee Ong,Puay Hoon Tan,Swee Ho Lim,Mabel Wong,Yoon Sim Yap,Jung Ah Lee,Mikael Hartman,Hui Miao,Ern Yu Tan,Joline Si Jing Lim ,Nur Aishah Mohd Taib ,Soo‐Chin Lee ,Peter Chan

doi:10.1002/cam4.985

Abstract

We aim to identify clinicopathologic predictors for response to neoadjuvant chemotherapy and to evaluate the prognostic value of pathologic complete response (pCR) on survival in Asia. This study included 915 breast cancer patients who underwent neoadjuvant chemotherapy at five public hospitals in Singapore and Malaysia. pCR following neoadjuvant chemotherapy was defined as 1) no residual invasive tumor cells in the breast (ypT0/is) and 2) no residual invasive tumor cells in the breast and axillary lymph nodes (ypT0/is ypN0). Association between pCR and clinicopathologic characteristics and treatment were evaluated using chi‐square test and multivariable logistic regression. Kaplan–Meier analysis and log‐rank test, stratified by other prognostic factors, were conducted to compare overall survival between patients who achieved pCR and patients who did not. Overall, 4.4% of nonmetastatic patients received neoadjuvant chemotherapy. The median age of preoperatively treated patients was 50 years. pCR rates were 18.1% (pCR ypT0/is) and 14.4% (pCR ypT0/is ypN0), respectively. pCR rate was the highest among women who had higher grade, smaller size, estrogen receptor negative, human epidermal growth factor receptor 2‐positive disease or receiving taxane‐based neoadjuvant chemotherapy. Patients who achieved pCR had better overall survival than those who did not. In subgroup analysis, the survival advantage was only significant among women with estrogen receptor‐negative tumors. Patients with poor prognostic profile are more likely to achieve pCR and particularly when receiving taxane‐containing chemotherapy. pCR is a significant prognostic factor for overall survival especially in estrogen receptor‐negative breast cancers.

Highlights

Neoadjuvant chemotherapy is offered to breast cancer patients with inoperable tumors or tumors that are too large for breast conservation, in order to allow for possible resection or breast conservation, respectively [1]
We aim to identify clinicopathologic and therapeutic predictors for response to neoadjuvant chemotherapy and evaluate the prognostic value of Pathologic complete response (pCR) on overall survival in a multi-
The number of patients diagnosed with breast cancer increased over time, there was no increase in the proportion of nonmetastatic breast cancer patients who were treated with neoadjuvant chemotherapy over the years. pCR rates among breast cancer patients who underwent neoadjuvant chemotherapy were 18.1% and 14.4%, respectively

Summary

Introduction

Neoadjuvant chemotherapy is offered to breast cancer patients with inoperable tumors or tumors that are too large for breast conservation, in order to allow for possible resection or breast conservation, respectively [1]. Term prognosis, was reported to be up to 45.8% when definition of pCR was taken as absence of invasive tumor in the breast but allow for in situ tumor [6, 7]. PCR ranges from 12% to 19.4% across various study populations when defined as no residual invasive or in situ tumor in the breast and axillary lymph nodes [8, 9]. Asian women present to a large extent with more advanced disease [14]. Given that Asian women present with larger tumors, neoadjuvant chemotherapy plays an even more important role.

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Conclusion