Meme kanseri neoadjuvan kemoterapi sürecinde progrese ve yanıtsız hastaların yanıtlı hastalar ile karşılaştırılması
Öz
Amaç: Meme kanseri neoadjuvan kemoterapi sürecinde radyolojik olarak progrese veya yanıtsız olup operasyona yönlendirilen hastalar ile tedaviye yanıtlı hastaların karşılaştırılması hedeflendi.
Gereç ve Yöntem: Hastanemizde meme kanseri nedeni ile neoadjuvan kemoterapi sonrası opere olmuş kadın hastalar retrospektif olarak tarandı. Ara radyolojik görüntülemesi olanlar çalışmaya dahil edildi. Hastalar ara görüntüleme sonuçlarına göre tedaviye yanıtlı, yanıtsız (stabil hastalık) ve progrese olmak üzere üç gruba ayrıldı. Yanıtsız veya progrese olup operasyona yönlendirilen hastalar ile yanıtlı olup kemoterapiye devam eden hastalar hasta ve tümör karakteristikleri bakımından ayrı ayrı karşılaştırıldı.
Bulgular: Çalışmaya toplam 96 kadın hasta dahil edildi. Ara radyolojik görüntüleme sonuçlarına göre hastaların %90,6’sı (87 hasta) tedaviye yanıtlıydı. Dört hasta (%4,2) tedaviye yanıtsızlık, beş hasta (%5,2) ise progresyon nedeni ile toplamda dokuz hasta (%9,4) erkenden operasyona yönlendirilmişti. Yanıtsız hastaların yanıtlı hastalara göre ortalama yaşı istatistiksel olarak anlamlı daha yüksek, tümör gradı ve Ki-67 indeksi ise daha düşük saptandı (sırasıyla; 60 vs. 49, p=0,035, 1,5 ± 0,6 vs. 2,4 ± 0,5, p=0,007 ve 10±4 vs. 37±22, p=0,003). Progrese olan hastaların yanıtlı hastalara göre tümör gradı ve Ki-67 indeksi daha yüksek olmasına rağmen istatistiksel anlamlı değildi. Tedaviye yanıtsız hastalar çoğunlukla luminal A (3/4 hasta), progrese hastalar ise çoğunlukla triple negatif (3/5 hasta) moleküler alt tipte idi.
Sonuç: Düşük proliferasyon indeksi ve gradı olan luminal meme kanserleri neoadjuvan kemoterapiye duyarsız olma eğilimindedir. Diğer taraftan yüksek proliferasyon indeksi ve gradı olan hormon reseptörleri negatif tümörler neoadjuvan tedaviye iyi yanıt verebildikleri gibi progresyon açısından da risk teşkil edebilirler. İleri klinik çalışmalara ihtiyaç vardır.
Anahtar Kelimeler
Meme kanseri neoadjuvan kemoterap ara radyolojik görüntüleme klinik yanıt
Kaynakça
- Asselain B, Barlow W, Barlett J, et al. Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018; 19 (1): 27-39.
- Tiwari A, Gogia A, Deo S, Shukla NK, Mathur S, and Sharma DN. Retrospective study of efficacy and safety of neoadjuvant docetaxel, carboplatin, and trastuzumab in HER2-positive locally advanced and oligometastatic breast cancer: An Indian experience. Indian J Cancer. 2017; 54 (1): 343-6.
- Raphael J, Paramsothy T, Li N, Lee J, and Gandhi S. A single-institution experience of salvage therapy for patients with early and locally advanced breast cancer who progress during neoadjuvant chemotherapy. Breast Cancer Res Treat. 2017; 163 (1): 11-9.
- Caudle AS, Gonzalez-Angulo AM, Hunt KK, et al. Predictors of tumor progression during neoadjuvant chemotherapy in breast cancer. J Clin Oncol. 2010; 28 (11): 1821-8.
- Keskin S, Muslumanoglu M, Saip P, et al. Clinical and pathological features of breast cancer associated with the pathological complete response to anthracycline-based neoadjuvant chemotherapy. Oncology. 2011; 81 (1): 30-8.
- Korde LA, Somerfield MR, Carey LA, et al. Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline. J Clin Oncol. 2021; 39 (13): 1485-505.
- Wang H, and Mao X. Evaluation of the Efficacy of Neoadjuvant Chemotherapy for Breast Cancer. Drug Des Devel Ther. 2020; 14: 2423-33.
- Choi MK, Park YH, Kil WH, et al. Clinicopathological features of early failure of neoadjuvant chemotherapy in locally advanced breast cancer. Cancer Chemother Pharmacol. 2014; 74 (3): 521-9.
- Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009; 45 (2): 228-47.
- Loibl S, Jackisch C, Lederer B, et al. Outcome after neoadjuvant chemotherapy in young breast cancer patients: a pooled analysis of individual patient data from eight prospectively randomized controlled trials. Breast Cancer Res Treat. 2015; 152 (2): 377-87.
- Nagao T, Kinoshita T, Hojo T, Tsuda H, Tamura K, and Fujiwara Y. The differences in the histological types of breast cancer and the response to neoadjuvant chemotherapy: the relationship between the outcome and the clinicopathological characteristics. Breast. 2012; 21 (3): 289-95.
- Al-Hilli Z, Choong G, Keeney MG, et al. Metaplastic breast cancer has a poor response to neoadjuvant systemic therapy. Breast Cancer Res Treat. 2019; 176 (3): 709-16.
- Gao JJ, and Swain SM. Luminal A Breast Cancer and Molecular Assays: A Review. Oncologist. 2018; 23 (5): 556-65.
- Haque W, Verma V, Hatch S, Suzanne Klimberg V, Brian Butler E, and Teh BS. Response rates and pathologic complete response by breast cancer molecular subtype following neoadjuvant chemotherapy. Breast Cancer Res Treat. 2018; 170 (3): 559-67.
- Chica-Parrado MR, Godoy-Ortiz A, Jiménez B, Ribelles N, Barragan I, and Alba E. Resistance to Neoadjuvant Treatment in Breast Cancer: Clinicopathological and Molecular Predictors. Cancers (Basel). 2020; 12 (8).
Comparison of progressed and unresponsive patients with responsive patients at ınterim assessment during breast cancer neoadjuvant chemotherapy
Öz
Aim: It was aimed to compare the breast cancer patients who were progressed or unresponsive to neoadjuvant chemotherapy with the patients clinically responsive to the treatment at interim radiological assessment.
Materials and Methods: Female patients operated in our hospital for breast cancer after neoadjuvant chemotherapy were retrospectively screened. Patients having interim radiological assessment were included in the study. Patients were divided into three groups as responsive, unresponsive (stable) and progressive according to the imaging results. Unresponsive and progressive patients were compared to responsive patients in terms of patient and tumor characteristics.
Results: A total of 96 patients were included in the study. According to the interim imaging results, 90.6% of patients (87 patients) had a radiological response to the treatment. Four patients (4.2%) with radiological unresponsiveness and five patients (5.2%) with radiological progression (9 patients in total, 9.4%) were referred to operation. The mean age of the unresponsive patients was found to be statistically higher than the responding patients (60 vs. 49, p=0.035). The tumor grade and Ki-67 index of unresponsive patients were lower than the responsive patients (respectively; 1.5±0.6 vs. 2.4±0.5, p=0.007 and 10±4 vs. 37±22, p=0.003). Although the tumor grade and Ki-67 index were higher in patients who progressed than the responders, they weren’t statistically significant. Unresponsive patients were mostly luminal A (3/4 patients), and progressive patients were mostly triple negative (3/5 patients) molecular subtype.
Conclusion: Luminal breast cancers with low proliferation index and grade tend to be insensitive to neoadjuvant chemotherapy. On the other hand, hormone receptor negative tumors with high proliferation index and grade may respond well to neoadjuvant chemotherapy and may also pose a risk for progression. Further clinical studies are needed.
Anahtar Kelimeler
Breast cancer neoadjuvant chemotherapy interim radiological imaging clinical response
Kaynakça
- Asselain B, Barlow W, Barlett J, et al. Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018; 19 (1): 27-39.
- Tiwari A, Gogia A, Deo S, Shukla NK, Mathur S, and Sharma DN. Retrospective study of efficacy and safety of neoadjuvant docetaxel, carboplatin, and trastuzumab in HER2-positive locally advanced and oligometastatic breast cancer: An Indian experience. Indian J Cancer. 2017; 54 (1): 343-6.
- Raphael J, Paramsothy T, Li N, Lee J, and Gandhi S. A single-institution experience of salvage therapy for patients with early and locally advanced breast cancer who progress during neoadjuvant chemotherapy. Breast Cancer Res Treat. 2017; 163 (1): 11-9.
- Caudle AS, Gonzalez-Angulo AM, Hunt KK, et al. Predictors of tumor progression during neoadjuvant chemotherapy in breast cancer. J Clin Oncol. 2010; 28 (11): 1821-8.
- Keskin S, Muslumanoglu M, Saip P, et al. Clinical and pathological features of breast cancer associated with the pathological complete response to anthracycline-based neoadjuvant chemotherapy. Oncology. 2011; 81 (1): 30-8.
- Korde LA, Somerfield MR, Carey LA, et al. Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline. J Clin Oncol. 2021; 39 (13): 1485-505.
- Wang H, and Mao X. Evaluation of the Efficacy of Neoadjuvant Chemotherapy for Breast Cancer. Drug Des Devel Ther. 2020; 14: 2423-33.
- Choi MK, Park YH, Kil WH, et al. Clinicopathological features of early failure of neoadjuvant chemotherapy in locally advanced breast cancer. Cancer Chemother Pharmacol. 2014; 74 (3): 521-9.
- Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009; 45 (2): 228-47.
- Loibl S, Jackisch C, Lederer B, et al. Outcome after neoadjuvant chemotherapy in young breast cancer patients: a pooled analysis of individual patient data from eight prospectively randomized controlled trials. Breast Cancer Res Treat. 2015; 152 (2): 377-87.
- Nagao T, Kinoshita T, Hojo T, Tsuda H, Tamura K, and Fujiwara Y. The differences in the histological types of breast cancer and the response to neoadjuvant chemotherapy: the relationship between the outcome and the clinicopathological characteristics. Breast. 2012; 21 (3): 289-95.
- Al-Hilli Z, Choong G, Keeney MG, et al. Metaplastic breast cancer has a poor response to neoadjuvant systemic therapy. Breast Cancer Res Treat. 2019; 176 (3): 709-16.
- Gao JJ, and Swain SM. Luminal A Breast Cancer and Molecular Assays: A Review. Oncologist. 2018; 23 (5): 556-65.
- Haque W, Verma V, Hatch S, Suzanne Klimberg V, Brian Butler E, and Teh BS. Response rates and pathologic complete response by breast cancer molecular subtype following neoadjuvant chemotherapy. Breast Cancer Res Treat. 2018; 170 (3): 559-67.
- Chica-Parrado MR, Godoy-Ortiz A, Jiménez B, Ribelles N, Barragan I, and Alba E. Resistance to Neoadjuvant Treatment in Breast Cancer: Clinicopathological and Molecular Predictors. Cancers (Basel). 2020; 12 (8).
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Eylül 2022 |
| Gönderilme Tarihi | 6 Ekim 2021 |
| Yayımlandığı Sayı | Yıl 2022 |