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Tumor Subtype Impacts Surgical Approach And Pathological Response To Neoadjuvant Chemotherapy In Node-Positive Breast Cancer Patients - Findings From A Prospective Multicenter Clinical Trial (ACOSOG Z1071 [Alliance])
Judy C Boughey*1, Linda McCall*2, Karla Ballman*1, Elizabeth A Mittendorf*3, Gretchen Ahrendt*4, Lee Wilke*5, Bret Taback*6, A Marilyn Leitch*7, Teresa Flippo-Morton*8, Kelly K Hunt3
1Mayo Clinic, Rochester, MN;2Duke University, Durham, NC;3M.D. Anderson Cancer Center, Houston, TX;4University of Pittsburgh Cancer Institute, Pittsburgh, PA;5University of Wisconsin Hospital and Clinics, Madison, WI;6Columbia University Medical Center, New York, NY;7University of Texas Southwestern Medical Center, Dallas, TX;8Carolinas Medical Center/Levine Cancer Institute, Charlotte, NC
OBJECTIVES
Pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) correlates with improved outcomes. We sought to evaluate pCR rates and breast conservation rates after NAC according to tumor subtype.
METHODS
ACOSOG Z1071 was a prospective, multicenter study assessing sentinel node surgery after NAC in patients presenting with node-positive breast cancer from 2009 to 2011. We evaluated surgical procedure and pathologic response after NAC in relation to approximated tumor subtype based on estrogen and progesterone receptor and HER2 status.
RESULTS
Of 701 eligible patients, surgical pathology was available in 694. Tumor subtype was triple negative (TN) in 170 (24%), HER2-positive in 207 (30%) and hormone receptor-positive, HER2-negative in 317 (46%). Patient age, clinical tumor and nodal stage at presentation did not differ across subtypes. pCR rates in both the breast and axilla were 38% in TN, 45% in HER2-positive and 11% in hormone receptor-positive, HER2-negative disease (p <0.0001). Similarly, axillary pCR rates and breast pCR varied across subtypes, being highest in HER2-positive and TN subtypes (see table). Breast conserving surgery rates were significantly higher in TN and HER2-positive patients (p=0.024).
CONCLUSIONS
Patients with triple negative or HER2-positive breast cancer have the highest pCR rates in the breast and the axilla and highest rates of breast conservation. Patients with these subtypes are most likely to be candidates for less invasive surgical approaches following NAC.
| All Patients | Triple Receptor Negative | HER2-positive | Hormone Receptor-positive; HER2-negative | P value | |
| Number of patients (%) | 694 | 170 (24%) | 207 (30%) | 317 (46%) | |
| Patient age <50 50-59 61-69 70+ | 348 (50.1%) 205 (29.5%) 118 (17.0%) 23 (3.3%) | 77 (45.3%) 55 (32.4%) 32 (18.8%) 6 (3.5%) | 101 (48.8%) 63 (30.4%) 34 (16.4%) 9 (4.4%) | 170 (53.6%) 87 (27.4%) 52 (16.4%) 8 (2.5%) | 0.63 |
| T stage at presentation T0 Tis T1 T2 T3 T4 | 7 (1.0%) 1 (0.1%) 89 (12.8%) 384 (55.3%) 181 (26.1%) 32 (4.6%) | 3 (1.8%) 0 24 (14.1%) 100 (58.8%) 37 (21.8%) 6 (3.5%) | 3 (1.4%) 1 (0.5%) 23 (11.1%) 108 (52.2%) 62 (30.0%) 10 (4.8%) | 1 (0.3%) 0 42 (13.2%) 176 (55.5%) 82 (25.9%) 16 (5.0%) | 0.46 |
| Nodal stage at presentation N1 N2 | 658 (94.8%) 36 (5.2%) | 159 (93.5%) 11 (6.5%) | 196 (94.7%) 11 (5.3%) | 303 (95.6%) 14 (4.4%) | 0.62 |
| Surgery Breast Conserving Surgery Mastectomy | 278 (40.2%) 414 (59.8%) | 79 (46.8%) 90 (53.2%) | 89 (43.0%) 118 (57.0%) | 110 (34.8%) 206 (65.2%) | 0.024 |
| pCR (breast and axilla) | 194 (28.0%) | 65 (38.2%) | 93 (44.9%) | 36 (11.4%) | <0.0001 |
| pCR in breast | 233 (33.6%) | 81 (47.6%) | 103 (49.8%) | 49 (15.5%) | <0.0001 |
| pCR in axilla | 283 (40.8%) | 84 (49.4%) | 132 (63.8%) | 67 (21.1%) | <0.0001 |
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