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Tumor Biology and Response to Chemotherapy Impact Breast Cancer-Specific Survival in Node-Positive Breast Cancer Treated with Neoadjuvant Chemotherapy and Axillary Dissection: Long-Term Follow-Up from ACOSOG Z1071 (Alliance)
Judy C Boughey1, Karla Ballman2, Linda McCall3, Elizabeth A Mittendorf4, Thomas Julian5, David Byrd6, Kelly K Hunt4
1Mayo Clinic, Rochester, MN;2Weill Cornell Medicine, NY, NY;3Duke University, Durham, NC;4MD Anderson Cancer Center, Houston, TX;5Allegheny General Hospital, Pittsburgh, PA;6University of Washington Medical Center, Seattle, WA

OBJECTIVE(S):
Breast cancer-specific survival (BCSS) and factors associated with BCSS among women with node-positive disease treated with neoadjuvant chemotherapy (NAC) on a large clinical trial were examined.
METHODS:
ACOSOG Z1071 enrolled cT0-4N1-2 breast cancer patients treated with NAC from 2009-2011. All underwent axillary dissection. Factors impacting BCSS were analyzed.
RESULTS:
Median follow-up of 701 eligible patients was 4.1 years (0.3-6.5). 90 (12.8%) died from breast cancer. Factors impacting BCSS were tumor subtype and chemotherapy response (p<0.0001, table), which remained significant predictors of BCSS in multivariable analysis.
5-year BCSS was highest in HER2+ (95.7%), followed by hormone receptor (HR)+/HER2- (80.2%) and lowest in triple-negative (TNBC) (75.3%) (p<0.0001). Patients with residual disease in breast and nodes had poorer BCSS (74.8%) than patients with pathologic complete response (pCR) in breast only (93.7%), nodes only (93.1%) and both breast and nodes (95.0%) (p<0.0001).
In TNBC (n=171) 5-year BCSS was higher in pCR patients than without pCR (89.8% versus 66.7%, p=0.0036). In HER2-positive tumors (n=212) chemotherapy response was not associated with BCSS (96.6% versus 95.1%, p=0.65). In HR+/HER2- (n=318) BCSS was 100% in pCR patients and 78% in no pCR (n=NA).
CONCLUSIONS:
In node-positive breast cancer treated with NAC and axillary dissection, BCSS is lowest in TNBC with residual disease. BCSS is >95% in HER2+ patients treated with anti-HER2 therapy independent of chemotherapy response.
Support: U10CA180821, U10CA180882. ClinicalTrials.gov: NCT00881361


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