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. 2018 Jan:89:42-48.
doi: 10.1016/j.ejca.2017.10.036. Epub 2017 Dec 8.

The use of breast imaging for predicting response to neoadjuvant lapatinib, trastuzumab and their combination in HER2-positive breast cancer: Results from Neo-ALTTO

S Di Cosimo  1 , C Campbell  2 , H A Azim Jr  3 , G Galli  4 , G Bregni  5 , G Curigliano  6 , C Criscitiello  6 , M Izquierdo  7 , L de la Pena  8 , D Fumagalli  9 , L Fein  10 , J Vinholes  11 , W M J Ng  12 , M Colleoni  13 , A Ferro  14 , B J Naume  15 , A Patel  16 , J Huober  17 , M J Piccart-Gebhart  3 , J Baselga  18 , E de Azambuja  3
Affiliations

The use of breast imaging for predicting response to neoadjuvant lapatinib, trastuzumab and their combination in HER2-positive breast cancer: Results from Neo-ALTTO

S Di Cosimo et al. Eur J Cancer. 2018 Jan.

Abstract

Aim: To determine the value of mammography and breast ultrasound (US) in predicting outcomes in HER2 positive breast cancer patients (pts) within Neo-ALTTO trial.

Patients and methods: Mammography and US were required at baseline, week 6 and surgery. Two independent blinded investigators reviewed the measurements and assigned the corresponding response category. Pts showing complete or partial response according to RECIST (v1.1) were classified as responders. The association between imaging response at week 6 or prior to surgery was evaluated with respect to pathological complete response (pCR) and event-free Survival (EFS).

Results: Of the 455 pts enrolled in the trial, 267 (61%) and 340 (77%) had evaluable mammography and US at week 6; 248 (56%) and 309 (70%) pts had evaluable mammography and US prior to surgery. At week 6, 32% and 43% of pts were classified as responders by mammography and US, respectively. pCR rates were twice as high for responders than non-responders (week 6: 46% versus 23% by US, p < 0.0001; 41% versus 24% by mammography, p = 0.007). Positive and negative predictive values of mammography and US prior to surgery were 37% and 35%, and 82% and 70%, respectively. No significant correlation was found between response by mammography and/or US at week 6/surgery and EFS.

Conclusions: Mammography and US were underused in Neo-ALTTO although US had the potential to assess early response whereas mammography to detect residual disease prior to surgery. Our data still emphasise the need for further imaging studies on pts treated with neoadjuvant HER2-targeted therapy.

Keywords: Breast ultrasound; HER2 positive breast cancer; Mammography; Neoadjuvant; Targeted therapy.

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Conflict of interest statement

Conflict of interest statement

None declared.

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