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Breast Cancer Research and Treatment

, Volume 144, Issue 1, pp 153–162 | Cite as

Response and prognosis after neoadjuvant chemotherapy in 1,051 patients with infiltrating lobular breast carcinoma

  • Sibylle Loibl
  • Cristina Volz
  • Christine Mau
  • Jens-Uwe Blohmer
  • Serban D. Costa
  • Holger Eidtmann
  • Peter A. Fasching
  • Bernd Gerber
  • Claus Hanusch
  • Christian Jackisch
  • Sherko Kümmel
  • Jens Huober
  • Carsten Denkert
  • Jörn Hilfrich
  • Gottfried E. Konecny
  • Werner Fett
  • Elmar Stickeler
  • Nadia Harbeck
  • Keyur M. Mehta
  • Valentina Nekljudova
  • Gunter von Minckwitz
  • Michael Untch
Clinical trial

Abstract

Invasive lobular carcinomas (ILC) show better clinical behaviour compared with other histological types, but significantly lower pathological complete response (pCR) rates after neoadjuvant chemotherapy (NACT). We investigated whether factors influencing pCR rate in ILC after NACT can be identified and whether clinical outcome is different. 9,020 breast cancer patients from nine German neoadjuvant trials with known histological type were pooled. 11.7 % of tumours were ILC. Endpoints were: pCR rate, surgery type and survival. ILC was associated with older age, larger tumour size, lymph node negativity, lower grade and positive hormone-receptor-status (HR). Patients with ILC achieved a significantly lower pCR rate compared with non-ILC patients (6.2 vs. 17.4 %, P < 0.001). The pCR rate was 4.2 % in ILC/HR+/G1-2, 7.0 % in ILC with either HR− or G3, and 17.8 % in ILC/HR−/G3. Mastectomy rate was higher in ILC compared with non-ILC patients irrespective of response to NACT (pCR: 27.4 vs. 16.6 %, P = 0.037 and non-pCR: 41.8 % vs. 31.5 %, P < 0.0001). Age and HR independently predicted pCR in ILC. In ILC patients, pCR did not predict distant disease free (DDFS) and loco-regional disease free survival (LRFS), but overall survival (OS). Non-pCR patients with ILC had significantly better DDFS (P = 0.018), LRFS (P < 0.0001) and OS (P = 0.044) compared with non-ILC patients. Patients with ILC had a low chance of obtaining a pCR and this is not well correlated with further outcome. The mastectomy rate was considerably high in ILC patients even after obtaining a pCR. We, therefore, suggest to offer NACT mainly to ILC patients with HR-negative tumours.

Keywords

Breast cancer Invasive lobular carcinoma Non-lobular carcinoma Pathological complete response Neoadjuvant chemotherapy Survival 

Notes

Conflict of interest

The authors have declared no conflicts of interest.

Supplementary material

10549_2014_2861_MOESM1_ESM.pdf (98 kb)
Supplementary material 1 (PDF 97 kb)
10549_2014_2861_MOESM2_ESM.pdf (83 kb)
Supplementary material 2 (PDF 82 kb)

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sibylle Loibl
    • 1
    • 9
  • Cristina Volz
    • 2
  • Christine Mau
    • 2
  • Jens-Uwe Blohmer
    • 3
  • Serban D. Costa
    • 4
  • Holger Eidtmann
    • 5
  • Peter A. Fasching
    • 6
  • Bernd Gerber
    • 7
  • Claus Hanusch
    • 8
  • Christian Jackisch
    • 9
  • Sherko Kümmel
    • 10
  • Jens Huober
    • 11
  • Carsten Denkert
    • 12
  • Jörn Hilfrich
    • 13
  • Gottfried E. Konecny
    • 14
  • Werner Fett
    • 15
  • Elmar Stickeler
    • 16
  • Nadia Harbeck
    • 17
  • Keyur M. Mehta
    • 1
  • Valentina Nekljudova
    • 1
  • Gunter von Minckwitz
    • 1
    • 18
  • Michael Untch
    • 2
  1. 1.German Breast Group, GBG Forschungs GmbHNeu-IsenburgGermany
  2. 2.Department of Gynecology and Obstetrics, Multidisciplinary Breast Cancer CenterHelios Klinikum Berlin-BuchDuisburgGermany
  3. 3.Department of Gynecology and ObstetricsSt. Gertrauden KrankenhausBerlinGermany
  4. 4.Department of Obstetrics and GynecologyOtto-von-Guericke-UniversityMagdeburgGermany
  5. 5.Department of Obstetrics and GynecologyChristian-Albrecht-UniversityKielGermany
  6. 6.Department of Obstetrics and GynaecologyFriedrich-Alexander UniversityErlangenGermany
  7. 7.Department of Obstetrics and GynecologyKlinikum SüdRostockGermany
  8. 8.Department of SenologyRotkreuz-KlinikumMunichGermany
  9. 9.Department of Obstetrics and GynaecologySana KlinikumOffenbachGermany
  10. 10.Breast CentreKliniken-Essen-MitteEssenGermany
  11. 11.Department of Obstetrics and GynecologyUniversity of UlmUlmGermany
  12. 12.Department of PathologyCharitéBerlinGermany
  13. 13.Department of Obstetrics and GynecologyEilenriedklinikHannoverGermany
  14. 14.Division of Hematology-OncologyUniversity of CaliforniaLos AngelesUSA
  15. 15.Hematological-oncological PracticeWuppertalGermany
  16. 16.Department of Obstetrics and GynecologyUniversity of FreiburgFreiburgGermany
  17. 17.Breast CentreUniversity of MunichMunichGermany
  18. 18.Department of Gynaecology and ObstetricsUniversity HospitalFrankfurtGermany

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