11061 Background: Estrogen Receptor (ER) positive breast cancers have shown a lower rate of pathologic complete response (pCR) after neoadjuvant chemotherapy (NC) than ER negative tumors. However, the long-term benefits of adjuvant chemotherapy are evident in both subsets according to ER status. This might suggest some benefit for patients without pCR. Methods: Fifty-eight patients with ER positive locally-advanced breast cancer received NC with doxorubicin and paclitaxel (ATx3 ⟶wTx12) (Gianni L JCO 2005). RT-PCR assays were used to quantify expression of 384 genes on paraffin-embedded core biopsies. To reduce the possible confounding effect of the intermediate response phenotype, we developed a predictor comparing best responders (BR=pCR + breast residual ≤3 mm) versus gross residual disease (RD). An internal accuracy estimate was performed using complete leave-one-out cross validation. As external validation we applied the predictor’s genes derived from the Milan cases to an Affymetrix-based dataset of MD Anderson (Hess KR JCO 2006). The main differences of this dataset were the stage (I-III) and the NC regimen (Tx4 or wTx12 ⟶FACx4). A model based on the genes identified from the Milan cases was developed on a training set of MD Anderson cases and then applied in the validation set of the MD Anderson. All the analyses were performed by BRB-ArrayTools. Results: Nine best responder and 19 RD cases were identified. A 32 gene model was developed and complete cross-validation provided performance estimates of Accuracy 96%, Sensitivity 1.0, Specificity 0.95, PPV 0.9, NPV 1.0. Fifty-seven corresponding probes were identified on the Affymetrix platform. Nine pCR (breast) and 37 not- pCR ER positive cases were available in the training set. A 6 probes model (5 genes: TOP2A, MELK, BIRC5, KIFC1, BUB1 all higher in pCR- Breast group) was selected in the training set for its high sensitivity. This model was applied to 4 pCR and 30 not-pCR cases in the validation set and its performance was: Accuracy: 82%, Sens: 1, Spec: 0.8, PPV: 0.4, NPV:1. Conclusions: The identified genes provided good predictive accuracy in slightly dissimilar clinical cases from different institutions assayed on a different platform. An external validation of the identified models is warranted. No significant financial relationships to disclose.
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