Revisiting pCR, partial response, and prognosis

'lizbeth · 11-15-2014, 10:03 AM

I am still looking for the latest pCR data, but am resharing this posting from Lani on partial response:

Quote:

Ki67 decreased markedly (>80%), according to new article(abstract below)

This held for her2+ bc as well as other subtypes according to the article

ABSTRACT: Survival outcome and reduction rate of Ki-67 between pre- and post-neoadjuvant chemotherapy in breast cancer patients with non-pCR
[Breast Cancer Research and Treatment]

The research question of this investigation is whether the reduction rate of Ki-67 after neoadjuvant chemotherapy (NAC) could indicate a survival in patients with non-pCR. A total of 455 patients had received NAC, and subsequent surgery was analyzed retrospectively. Patients with non-pCR were divided into three subgroups according to Ki-67 change: High-reduction (the absolute value of Ki-67 was reduced by >80 % compared with that prior to NAC), Low-reduction (the absolute value of Ki-67 was reduced by 0-80 % compared with that prior to NAC), and Increase group (the absolute value of Ki-67 was increased compared with that prior to NAC). The relapse-free survival (RFS) rates were compared among subgroups. pCR was achieved in 93 patients (20.4 %). In patients with non-pCR, the median reduction rate of Ki-67 was 60 %. A total of 15 % of patients were in the High-reduction, 63 % in the Low-reduction, and 22 % in the Increase group. The median follow-up period was 64.5 months. The 5-year RFS rates among the three groups were significantly different (p < 0.0001), and the differences were also observed in the HER2 (p = 0.033), triple-negative (p = 0.034), and luminal-like subtypes (p = 0.001). Patients in the High-reduction group showed comparable RFS to that of patients with pCR (p = 0.363). In patients with non-pCR, the reduction rate of Ki-67 after NAC significantly predicted RFS regardless of cancer subtypes. Therefore, patients who are non-pCR but who achieve a high reduction of Ki-67 can be expected to have a favorable prognosis similar to that of patients with pCR.

My goal is to share with those who have had a complete response or partial response the experience of others - so perhaps our fellow board members can worry less . . . and enjoy their recovery from cancer treatment more.

KathyT · 11-15-2014, 08:19 PM

Hi Lizbeth, thank you for this post. I did not get pCR after neoadjuvent chemo. I must say I was very upset and scared even though we don't really know what that means since NAC is a more recent way of doing things. Anyway, what I get from this is that the tissue that was removed after surgery should be tested and path results should be done to see what the Ki-67 is. I don't know if path results were done on it, I will call my surgeon and find out!!

'lizbeth · 11-16-2014, 08:57 AM

Kathy,

Cancer can be scary, however many of us worry too much (myself included) about things that will never happen (recurrence).

Did you have a partial response to TCHP?

Ask him if the number for your ER+ changed as well as Ki-67.

Best wishes for NED

KathyT · 11-16-2014, 09:22 AM

I did lizbeth, there were only 2mm and a 4mm area of cancer left behind and lymph nodes were clean at the time of surgery. Thanks!

'lizbeth · 11-16-2014, 10:04 PM

That sounds very positive. I am really glad the lymph nodes were clean and the cancer shrunk so much.

AmyWeiss · 06-01-2015, 09:37 AM

Hi Lizbeth,

Thanks for posting this. I could really use your help! I was diagnosed stage IIB, HER2+, ER-,PR- , one positive node, in Dec, 2014. After receiving 6 rounds of TCHP and then a bilateral mastectomy 2 weeks ago, I just got my pathology report. Unfortunately, I did not get a pCR (crushing!) though they said my response was pretty good -- the breast tumor was gone and cancer in my node was nearly gone- 4.5 mm left. (8 other nodes removed- all clear). However, because of the cancer left on node, my doctor has suggested I go in for more chemo, AC this time, because she is worried about rogue cells in my body. I will do anything to reduce my risk of recurrence, but I'm super nervous that I didn't get pCR after what I've been reading in the research (and also about going on AC frankly). Should I request they check the Ki-67? Anything else I should be asking? What do you think about using AC at this point?
Thank you!
Amy
San Francisco

KathyT · 06-01-2015, 04:57 PM

Amy,
I would maybe get a second opinion?? I think I would request Ki-67! I did have clean lymph nodes but did not get pcr in my 2 small tumors in my breast. I asked my MO about more chemo after I found out I did not get pcr(I was crushed too) and he did not recommend it.
Best of luck to you!!

ConcernedStu · 06-02-2015, 03:55 AM

Hi Amy, my loved one's response to chemo was almost the exact same as yours, what a coincidence! I like you was crushed, but it is a very good response. AC chemo alone is not as effective in her2+ and it is viewed by more as the tougher chemo. In my loved one's case, she got strong radiation and the year of herceptin, as well as tamox because of hr+. No more chemo.

I would definitely seek a second opinion, you will drive yourself crazy thinking of what ifs.

Re: worrying about the lack of complete response. Only 40-60% (based on the studies I've read) have a pcr with perjeta, so people with a non full response is a substantial group, you are not alone. Hope this helps.

AmyWeiss · 06-02-2015, 07:54 PM

Thanks Kathy and ConcernedStu. I appreciate your sharing.

I definitely was hopeful for pCR because my response seemed to be so good during treatment (and mostly it was since tumor in breast was gone). I keep wondering if the cancer on node was just so fibrous that the chemo couldn't get it all. Unfortunately, because I don't have ER+ cancer, my doctor can't give me Tamoxifen or other estrogen-suppressing drugs, thus she has to be more aggressive with treatment to make sure any potential floating cells are zapped to smithereens. She's consulting with her tumor board now as well as others at a big conference in Chicago so I will hear her final recommendation soon but I am anticipating more chemo. If that's what it takes, I'm good with it. Like so many women here, I am a mom of young children and will do whatever they tell me. I keep thinking I may get more battle wounds but it's worth it as long as I win the war.

Hope everyone out there is winning their wars and kicking cancers ass!

KathyT · 06-02-2015, 09:01 PM

I hate Cancer and wish it didn't have to come in to any of our lives. I, like you have small children and would do anything to reduce the chance of it coming back. Please keep us posted!!

Best wishes
Kathy

thinkpositive · 06-03-2015, 09:19 AM

Amy,

Please keep us posted on what treatment they recommend for you. I am also ER/PR negative. Although I did have a pCR, I always wonder if they could have missed something in the nodes because they didn't to an axillary node dissection but rather a sentinal node biopsy. My cancer, like yours, was discovered in my nodes so I did have cancer in my nodes prior to treatment.

I like your Oncologists approach to be aggressive and get those remaining cancer cells. Sounds like you are in good hands.

Take care,
Brenda