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04-22-2016, 07:18 AM
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#1
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Senior Member
Join Date: Mar 2006
Posts: 4,778
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for those considering/undergoing neoadjuvant treatments, longterm statistics !!!!
based on presence/absence of in- breast & axillary pCR
[JAMA Oncology]
April 2016, Vol 2, No. 4 >
Original Investigation | April 2016
Ten-Year Outcomes of Patients With Breast Cancer With Cytologically Confirmed Axillary Lymph Node Metastases and Pathologic Complete Response After Primary Systemic Chemotherapy
Sarah S. Mougalian, MD1; Mike Hernandez, MS2; Xiudong Lei, PhD2; Siobhan Lynch, MD3; Henry M. Kuerer, MD, PhD4; William F. Symmans, MD5; Richard L. Theriault, DO6; Bruno D. Fornage, MD7; Limin Hsu, MS6; Thomas A. Buchholz, MD8; Aysegul A. Sahin, MD5; Kelly K. Hunt, MD4; Wei Tse Yang, MD7; Gabriel N. Hortobagyi, MD6; Vicente Valero, MD6
[+] Author Affiliations
JAMA Oncol. 2016;2(4):508-516. doi:10.1001/jamaoncol.2015.4935. Text Size: A A A
ABSTRACT
Importance The long-term effect of axillary pathologic complete response (pCR) on survival among women with breast cancer treated with primary systemic chemotherapy (PST) is unknown.
Objective To assess the long-term effect of axillary pCR on relapse-free survival (RFS) and overall survival (OS) in women with breast cancer with cytologically confirmed axillary lymph node metastases treated with PST.
Design, Setting, and Participants We retrospectively analyzed the effect of axillary pCR on 10-year OS and RFS among all women who received a diagnosis of breast cancer stages II to III with cytologically confirmed axillary metastases between 1989 and 2007 who received PST at a large US comprehensive cancer center. Women were stratified by post-PST axillary status, and survival outcomes were estimated and compared according to response in the breast and axilla.
Main Outcomes and Measures Outcomes of interest were RFS and OS.
Results Of 1600 women treated, median (range) age at diagnisis was 49 (21-86) years. A total of 454 (28.4%) achieved axillary pCR. These patients were more likely to have human epidermal growth factor receptor 2 (HER2)-positive and triple-negative disease (P < .001), pCR in the breast (P < .001), high-grade tumors (P < .001), and lower clinical and pathologic T stage (P = .002). Ten-year OS rates were 84% (95% CI, 79%-88%) and 57% (95% CI, 54%-61%) (P < .001) and 10-year RFS rates 79% (95% CI, 74%-83%) and 50% (95% CI, 46%-53%) (P < .001) for patients with axillary pCR and residual axillary disease, respectively. For patients with axillary pCR, 10-year OS rates were 90% (95% CI, 84%-94%) for those with breast pCR and 72% (95% CI, 61%-80%) for those with residual breast disease (P < .001). For patients with residual axillary disease, 10-year OS rates were 66% (95% CI, 56%-74%) for patients with and 56% (95% CI, 52%-60%) for patients without breast pCR (P = .02). Of patients receiving HER2-targeted therapy for HER2-positive disease, 67.1% (100 of 149) achieved axillary pCR; 10-year OS rates were 92% (95% CI, 84%-96%) and 57% (95% CI, 20%-82%) (P = .003) and 10-year RFS rates 89% (95% CI, 81%-94%) and 44% (95% CI, 18%-68%) (P < .001) for those with axillary pCR and residual axillary disease, respectively.
Conclusions and Relevance Axillary pCR was associated with improved 10-year OS and RFS. Patients with axillary and breast pCR after PST had superior long-term survival outcomes. Patients undergoing HER2-targeted therapy for HER2-positive disease had high rates of axillary pCR, and those with axillary pCR had excellent 10-year OS.
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04-22-2016, 06:54 PM
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#2
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Senior Member
Join Date: May 2014
Location: San Diego
Posts: 411
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Re: for those considering/undergoing neoadjuvant treatments, longterm statistics !!!!
Lani,
Thanks so much for posting this. I'm looking forward to being one of great long term statistics. I was one of the fortunate ones who achieved a PCR so I'm hoping for the best.
Thanks again,
Brenda
__________________
8/2013 Diagnosed IDC Left Breast ER-/PR-/HER2+ Stage 3C, DCIS ER+/PR+/HER2- Right Breast (54 yr)
8/2013 PET/CT scan shows mass in uterues and suprclavicular nodes
8/20/13 Begin 6 rounds TCH chemo, Perjeta added for rounds 4-6
9/2013 After 1st round of chemo, mass in neck and breast no longer able to feel
11/2013 Hysterectomy, mass from PET/CT scan not cancer (adenomylosis)
12/2013 Finished chemo
1/2014 Double mastectomy with chest expanders
1/2014 Pathology report from surgery and SNB show complete pathological response!
3/2014 Finish IMRT radiation
8/2014 Fat transfer to radiated breast
8/2014 Completed 1 yr of Herceptin
10/2014 exchange surgery expanders removed implants placed
6/2015 3D nipple and areola tattoos
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05-01-2016, 10:11 PM
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#3
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Senior Member
Join Date: Aug 2014
Location: Seattle, WA
Posts: 285
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Re: for those considering/undergoing neoadjuvant treatments, longterm statistics !!!!
I had only 3 nodes removed after neoadjuvant TCHP two years ago. All my scans in the past year have remained clean -- just that HER2+ idiosynchratic tendency to go to the brain as the first site of mets.
Good to know that if the mutant cell line in my head was destroyed that it might not come back elsewhere.
__________________
- Dx 2/14 3b HER2+/HR- left breast, left axilla, internal mammary node (behind breast bone). Neoadjuvant TCHP 3/14-7/2. PCR 8/14 LX and SND. 10/21-12/9 Proton therapy to chest wall.
- Dx 7/20/15 cerebellar met 3.5x5cm HER2+/HR-/GATA3+ 7/23/15 Craniotomy.
- 7/29/15 bone scan clear. 8/3/15 PET clean scan. LINAC SRS (5 fractions) Sept 2015. 9/17/15 CSF NED, 9/24/15 CSF NED, 11/2/15 CSF NED.
- 10/27/15 atypical uptake in right cerebellum - inflammation?
- 12/1/15 Leptomeningeal dx. Starting IT Herceptin.
- 1/16 - 16 fractions of tomotherapy to cerebellum, break of IT Herceptin during rads, resume at 100 mg weekly
- 3/2016 - stable scan
- 5/2016 stable scan
- 7/2016 pseudoprogression?
- 9/2016 more LM, start new chemo protocol and IV therapy treatment with HBOT
- 11/2016 Cyberknife to temporal lobe, HBOT just prior
- 12/2016 - lesions starting to show shrinkage
- 8/2017 - Stable since Dec 2016. Temporal lobe lesion gone.
- Using TCM, naturopathic oncology, physical therapy, chiro, massage, medical qigong, and energetic healing modalities in tandem. Stops at nothing.
- Mother of 2 boys - ages 7 and 10 (8/2017) and a lovely partner with lots to live for.
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05-07-2016, 07:01 PM
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#4
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Senior Member
Join Date: Jun 2014
Posts: 113
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Re: for those considering/undergoing neoadjuvant treatments, longterm statistics !!!!
I had PCR too and am looking forward to many more years of survival. Thank you for posting!
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5/15/14 Dx IDC, right breast, 2 cm with 3 cm lymph node ER/PR- Her2+
6/11/14 Taxol / Herceptin / Perjeta
9/17/14 Lumpectomy, axillary lymph node dissection 3/9 nodes showed previous involvement but all clear due to THP!!
9/24/14 NED
10/8/14 AC x 4
12/16/14 rads x 20 WBRT only
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