Abstract
In current clinical practices, up to 27% of all breast cancer patients receive neoadjuvant chemotherapy. High pathological complete response rate is frequently associated with tumor-infiltrating lymphocytes. Additionally, circulating immune cells are also often linked to chemotherapy response.We performed a retrospective analysis on a cohort of 112 breast cancer patients (79 triple-negative, 33 hormone receptor-negative/HER2-positive) treated with standard neoadjuvant chemotherapy. Eosinophil and lymphocyte counts were collected from whole blood at baseline and during follow-ups and their associations with pathological complete response, relapse, disease-free and breast cancer-specific survival were analyzed.We observed a higher pathological complete response rate in patients who presented at baseline a relative eosinophil count ≥ 1.5% (55.6%) than in those with a relative eosinophil count < 1.5% (36.2%)(p = 0.04). An improvement in breast cancer-specific survival in patients with high relative eosinophil count (p = 0.05; HR = 0.336; 95% CI = 0.107–1.058) or with high relative lymphocyte count (threshold = 17.5%, p = 0.01; HR = 0.217; 95% CI = 0.060–0.783) were also observed. Upon combining the two parameters into the eosinophil x lymphocyte product with a threshold at 35.8, associations with pathological complete response (p = 0.002), relapse (p = 0.028), disease-free survival (p = 0.012) and breast cancer-specific survival (p = 0.001) were also recorded.In conclusion, the relative eosinophil count and eosinophil x lymphocyte product could be promising, affordable and accessible new biomarkers that are predictive for neoadjuvant chemotherapy response and prognostic for longer survival in triple-negative and hormone receptors-negative/HER2-positive breast cancers. Confirmation of these results in a larger patient population is needed.
Highlights
Breast cancer is the most common cancer and the leading cause of cancer-related death in women worldwide, with 1.67 million new cases and 522,000 deaths each year [1]
112 early breast cancer patients treated with neoadjuvant chemotherapy (NAC) at the University Hospital of Liege (CHU Liege) between December 2005 and November 2017 were included in the analysis
We analyzed the effect of eosinophils and lymphocytes on response to neoadjuvant chemotherapy and survival in hormone receptor (HR)-/HER2+ breast cancer
Summary
Breast cancer is the most common cancer and the leading cause of cancer-related death in women worldwide, with 1.67 million new cases and 522,000 deaths each year [1]. Neoadjuvant treatment has become the main strategy to turn inoperable tumors into operable tumors and to allow for more frequent conservative breast surgery. Approximately 7–27% of all new breast cancers in high-income countries are treated with neoadjuvant chemotherapy (NAC) treatment [2]. Evidence supporting the association between pCR and survival benefit has been previously demonstrated, especially for aggressive tumors such as triple-negative breast cancer (TNBC) and hormone receptor-negative/ HER2-positive (HR−/HER2+) cancer [3,4,5,6]. Higher pCR rates were observed for TNBC and HR−/HER2+ breast cancers compared to luminal subtypes. Such a higher pCR rate was associated with a longterm benefit [4, 7, 8]
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