Recent Publications
On this page you will find information about and links to relevant neoadjuvant systematic therapy publications
Summary
This study evaluated histological pattern of residual tumour in patients who received neoadjuvant chemotherapy (NACT) in order to determine whether this affected oncological outcomes. The study cohort included 975 patients (median follow up 74 months) treated with NACT between 2004 and 2014. The 10 year locoregional recurrence (LRR), relapse free survival (RFS), and overall survival (OS) rates were 9.8%, 67.6%, and 74.4% respectively. The pattern of residual disease was not significantly associated with LRR risk. However, patients with either scattered residual tumour or no/minimal response had worse RFS (scattered: HR 2.0, p=0.015; no/minimal response: HR 2.2, p=0.021) and OS (scattered: HR 2.2, p=0.026; no/minimal response: HR 2.5, p=0.023) when compared to concentric pattern of response. These findings were most prominent in patients with triple negative breast cancer.
Summary
This prospective multicentre cohort study aimed to determine surgical decision-making in the breast and axilla, as well as pathological complete response (pCR) rate in patients undergoing neoadjuvant chemotherapy (NACT). 1283 patients were recruited from 39 UK breast units (Dec 2017-Nov 2018). Complete histopathological and surgical outcomes were available for 900 patients. Overall pCR rate in the breast was 41.4%, with pCR rate of 36% in node positive tumours (ypT0/is, ypN0). Based on tumour subtype, pCR rate was highest in HER2+ tumours (70.2% for ER-HER2+ and 47.3% for ER+HER2+), 41.9% for triple negative breast cancer (TNBC), and 14.9% for ER+HER2- tumours. At diagnosis, 486 tumours were ineligible for breast conserving surgery (BCS) whereas 350 were deemed suitable for BCS. Following NACT, 176/486 (36.2%) of these tumours were converted from mastectomy to BCS due to sufficient disease downstaging. The intention to resect the original tumour footprint was stated by 44.8%, whereas 55.2% stated the intention to resect the post-treatment tumour footprint. Margin positivity rate was 11.4% with final overall mastectomy rate of 45.9% when re-excisions were considered. With regards to the axilla, most patients with cN0 disease underwent SLNB post-NACT (82.9%). For the 405 patients who underwent SLNB post-NACT, positive nodes were detected in 7.4% on pathology assessment. For the 385 patients who received axillary node clearance post-NACT, 186 patients (48.3%) were found to have negative nodes on pathology assessment.
Summary
This prospective multicentre trial investigated the accuracy of ultrasound-guided biopsies identifying breast pathologically complete response (pCR) after neoadjuvant systemic therapy (NST) in patients with radiological partial (rPR) or complete (rCR) on MRI. Eight ultrasound-guided 14-G core biopsies were obtained before surgery close to the marker clip. Pre-surgical biopsies were obtained in 167 patients (136 rCR / 31 rPR) who had hormone receptor positive/HER2 negative (38%), HER2 positive (38%), or triple negative (36%) breast cancer. The pCR rate was 53% in the entire cohort. Of 78 patients who had residual disease, biopsies were false negative in 29 patients (37%). the multivariable significantly associated with false negative biopsy was rCR (FNR 47%; p=0.01).
Summary
This systematic review and meta-analysis examined whether the timing of surgery post-neoadjuvant chemotherapy (NACT) impacted overall survival (OS) and disease free survival (DFS). Five studies (including 8794 patients) were eligible for inclusion. Patients who had surgery <8 weeks post-NACT had significantly improved OS (OR 0.47) and DFS (OR 0.71). Furthermore, there were no survival advantages in having surgery <4 weeks post-NACT with no difference in pCR rate between those that had surgery <4 weeks and 4-8 weeks post-NACT.
Annals of Surgery: Mar 2020 - Volume 271 - Issue 3 – p574-580
This study examined pathological complete response (pCR) in the breast and the axilla in 4084 patients treated with neoadjuvant chemotherapy (NACT). The data was derived from the Netherlands Cancer Registry. Overall breast pCR rate of 24.1% was observed in cT1-3N0-1 breast cancer patients treated with NACT. In patients who achieved breast pCR, 97.7% of clinically node negative (cN0) patients had no tumour in the lymph nodes (ypN0) post-NACT. Furthermore, 45% of cN1 patients had converted to ypN0 after NACT. The study findings support the need for future clinical trials to investigate potential de-escalation of axillary surgery in this patient cohort when image-guided tissue sampling identifies a breast pCR.