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. 2024 Feb;13(3):e6930.
doi: 10.1002/cam4.6930. Epub 2024 Feb 7.

Neoadjuvant chemotherapy for breast cancer: Pathologic response rates but not tumor size, has an independent prognostic impact on survival

Gilles Houvenaeghel  1 , Alexandre de Nonneville  2 , Monique Cohen  1 , Laura Sabiani  1 , Max Buttarelli  1 , Emmanuelle Charaffe  3 , Aurélie Jalaguier  4 , Marie Bannier  1 , Agnès Tallet  5 , Frédéric Viret  2 , Anthony Gonçalves  2
Affiliations

Neoadjuvant chemotherapy for breast cancer: Pathologic response rates but not tumor size, has an independent prognostic impact on survival

Gilles Houvenaeghel et al. Cancer Med. 2024 Feb.

Abstract

Aim: We investigated the pathologic complete response rates (pCR) and survival outcomes of early breast cancer patients who underwent neoadjuvant chemotherapy (NAC) over 14 years at a French comprehensive cancer center and reported pCR and survival outcomes by tumor subtypes and size.

Methods: From January 2005 to December 2018, 1150 patients receiving NAC were identified. Correlations between cT stage, breast tumor response, axillary lymph node response, pCR, surgery, and outcomes were assessed. pCR was defined as (ypT0/ypTis) and (ypN0/pN0sn).

Results: A pCR was reached in 31.7% (365/1150) of patients and was strongly associated with tumor subtypes, but not with tumor size (pretreatment cT category). Luminal-B Her2-negative and triple-negative (TN) subtypes, cN1 status, older age, and no-pCR had an independent negative prognostic value. Overall survival (OS), relapse-free survival (RFS), and metastasis-free survival (MFS) were not significantly different for cT0-1 compared to cT2 stages. In Cox-model adjusted on in-breast pCR and pN status, ypN1 had a strong negative impact (OS, RFS, and MFS: HR = 3.153, 4.677, and 6.133, respectively), higher than no in-breast pCR (HR = 2.369, 2.252, and 2.323). A negative impact of no pCR on OS was observed for cN0 patients and TN tumors (HR = 4.972) or HER2-positive tumors (HR = 11.706), as well as in Luminal-B Her2-negative tumors on MFS (HR = 2.223) and for Luminal-A on RFS (HR = 4.465) and MFS (HR = 4.185).

Conclusion: Achievement of pCR, but not tumor size (pretreatment cT category), has an independent prognostic impact on survival. These results suggest potential NAC benefits in patients with small tumors (<2 cm), even in absence of clinically suspicious lymph nodes. Residual lymph node disease after NAC is the most powerful adverse prognostic factor.

Trial registration: ClinicalTrials.gov NCT02869607.

Keywords: breast cancer; neoadjuvant chemotherapy; pathologic response; survival.

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Conflict of interest statement

Alexandre de Nonneville declares Consulting fees by Gilead, Seagen, Lilly, and Novartis, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events by Gilead, Daiichi Sankyo, and MSD, Support for attending meetings and/or travel by Gilead, Lilly, and Daiichi Sankyo. Emmanuelle Charaffe declares payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events by Exact Science (to institution), Veracyte (to institution), and AstraZeneca. Anthony Gonçalves declares Support for attending meetings and/or travel by Menarini, Participation on a Data Safety Monitoring Board or Advisory Board by Novartis, MSD, and Daiichi Sankyo. No conflict of interest was declared by others authors.

Figures

FIGURE 1
FIGURE 1
(A) Overall survival (OS), (B) recurrence free survival (RFS), and (C) metastases free survival (MFS) according to pCR in multivariate analysis. HR, Hazard ratio; pCR, pathologic complete response.
FIGURE 2
FIGURE 2
Overall survival according to cT stage in multivariate analysis for patients with cN0 triple negative (A) and Her2‐positive tumors (B).
See this image and copyright information in PMC

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