Neoadjuvant systemic therapy for breast cancer: the Westmead experience

Annelise M. Cocco, David Messer, Alexander Brown, Nina Sriram, Jenny Gilchrist, Loma Al-Mansouri, Richard Kefford, Farid Meybodi, James French, Jeremy Hsu, Elisabeth Elder

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Neoadjuvant systemic therapy (NAST) can be used to treat breast cancer. Pathologic complete response (pCR) is a surrogate marker for improved survival. This study examined response in the breast and axilla to NAST and identified features associated with pCR. Methods: Patients undergoing NAST and surgery between January 2012 and June 2016 by surgeons at Westmead Breast Cancer Institute were identified. Patients with inflammatory or metastatic disease were excluded. Data were analysed to identify factors predictive of pCR. Results: Ninety-one patients were identified. Mean age was 49 years. Forty-one patients had axillary metastases identified prior to NAST. Eighty-three patients received chemotherapy alone, six endocrine therapy alone and two had both. Thirty-seven patients had mastectomy and 54 had breast-conserving surgery. The overall breast pCR rate was 29% higher in patients with triple-negative (50%) or HER2-positive (39%) disease and lower in luminal disease (11.6%, P = 0.001). Forty percent of node-positive patients became node negative. The only variable associated with pCR was tumour biology. Patients with HER2-positive breast cancer were more likely to have axillary pCR than those with luminal cancer (odds ratio: 28, P = 0.00005). Conclusion: pCR in either the breast or axilla was most likely to be achieved in patients with HER2-positive or triple-negative breast cancers. In patients with luminal cancers, the goal of NAST is best considered to facilitate surgical options rather than obtaining a pCR.

LanguageEnglish
Pages640-644
Number of pages5
JournalANZ Journal of Surgery
Volume88
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018

Fingerprint

Neoadjuvant Therapy
Breast Neoplasms
Axilla
Breast
Triple Negative Breast Neoplasms
Neoplasms
Segmental Mastectomy
Mastectomy
Biomarkers
Odds Ratio
Neoplasm Metastasis

Keywords

  • breast cancer
  • neoadjuvant therapy

Cite this

Cocco, A. M., Messer, D., Brown, A., Sriram, N., Gilchrist, J., Al-Mansouri, L., ... Elder, E. (2018). Neoadjuvant systemic therapy for breast cancer: the Westmead experience. ANZ Journal of Surgery, 88(6), 640-644. https://doi.org/10.1111/ans.14158
Cocco, Annelise M. ; Messer, David ; Brown, Alexander ; Sriram, Nina ; Gilchrist, Jenny ; Al-Mansouri, Loma ; Kefford, Richard ; Meybodi, Farid ; French, James ; Hsu, Jeremy ; Elder, Elisabeth. / Neoadjuvant systemic therapy for breast cancer : the Westmead experience. In: ANZ Journal of Surgery. 2018 ; Vol. 88, No. 6. pp. 640-644.
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Cocco, AM, Messer, D, Brown, A, Sriram, N, Gilchrist, J, Al-Mansouri, L, Kefford, R, Meybodi, F, French, J, Hsu, J & Elder, E 2018, 'Neoadjuvant systemic therapy for breast cancer: the Westmead experience', ANZ Journal of Surgery, vol. 88, no. 6, pp. 640-644. https://doi.org/10.1111/ans.14158

Neoadjuvant systemic therapy for breast cancer : the Westmead experience. / Cocco, Annelise M.; Messer, David; Brown, Alexander; Sriram, Nina; Gilchrist, Jenny; Al-Mansouri, Loma; Kefford, Richard; Meybodi, Farid; French, James; Hsu, Jeremy; Elder, Elisabeth.

In: ANZ Journal of Surgery, Vol. 88, No. 6, 01.06.2018, p. 640-644.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Cocco, Annelise M.

AU - Messer, David

AU - Brown, Alexander

AU - Sriram, Nina

AU - Gilchrist, Jenny

AU - Al-Mansouri, Loma

AU - Kefford, Richard

AU - Meybodi, Farid

AU - French, James

AU - Hsu, Jeremy

AU - Elder, Elisabeth

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N2 - Background: Neoadjuvant systemic therapy (NAST) can be used to treat breast cancer. Pathologic complete response (pCR) is a surrogate marker for improved survival. This study examined response in the breast and axilla to NAST and identified features associated with pCR. Methods: Patients undergoing NAST and surgery between January 2012 and June 2016 by surgeons at Westmead Breast Cancer Institute were identified. Patients with inflammatory or metastatic disease were excluded. Data were analysed to identify factors predictive of pCR. Results: Ninety-one patients were identified. Mean age was 49 years. Forty-one patients had axillary metastases identified prior to NAST. Eighty-three patients received chemotherapy alone, six endocrine therapy alone and two had both. Thirty-seven patients had mastectomy and 54 had breast-conserving surgery. The overall breast pCR rate was 29% higher in patients with triple-negative (50%) or HER2-positive (39%) disease and lower in luminal disease (11.6%, P = 0.001). Forty percent of node-positive patients became node negative. The only variable associated with pCR was tumour biology. Patients with HER2-positive breast cancer were more likely to have axillary pCR than those with luminal cancer (odds ratio: 28, P = 0.00005). Conclusion: pCR in either the breast or axilla was most likely to be achieved in patients with HER2-positive or triple-negative breast cancers. In patients with luminal cancers, the goal of NAST is best considered to facilitate surgical options rather than obtaining a pCR.

AB - Background: Neoadjuvant systemic therapy (NAST) can be used to treat breast cancer. Pathologic complete response (pCR) is a surrogate marker for improved survival. This study examined response in the breast and axilla to NAST and identified features associated with pCR. Methods: Patients undergoing NAST and surgery between January 2012 and June 2016 by surgeons at Westmead Breast Cancer Institute were identified. Patients with inflammatory or metastatic disease were excluded. Data were analysed to identify factors predictive of pCR. Results: Ninety-one patients were identified. Mean age was 49 years. Forty-one patients had axillary metastases identified prior to NAST. Eighty-three patients received chemotherapy alone, six endocrine therapy alone and two had both. Thirty-seven patients had mastectomy and 54 had breast-conserving surgery. The overall breast pCR rate was 29% higher in patients with triple-negative (50%) or HER2-positive (39%) disease and lower in luminal disease (11.6%, P = 0.001). Forty percent of node-positive patients became node negative. The only variable associated with pCR was tumour biology. Patients with HER2-positive breast cancer were more likely to have axillary pCR than those with luminal cancer (odds ratio: 28, P = 0.00005). Conclusion: pCR in either the breast or axilla was most likely to be achieved in patients with HER2-positive or triple-negative breast cancers. In patients with luminal cancers, the goal of NAST is best considered to facilitate surgical options rather than obtaining a pCR.

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Cocco AM, Messer D, Brown A, Sriram N, Gilchrist J, Al-Mansouri L et al. Neoadjuvant systemic therapy for breast cancer: the Westmead experience. ANZ Journal of Surgery. 2018 Jun 1;88(6):640-644. https://doi.org/10.1111/ans.14158