Advertisement

Evaluation of Residual Tumor After Neoadjuvant Treatment

  • Aziza Nassar
Chapter

Abstract

The primary benefit of neoadjuvant chemotherapy (NAC) is reduction of breast tumor size and conversion of positive lymph nodes into negative ones. In 70–90% of cases, clinical tumor response is evident depending on the type of chemotherapy and number of courses [1]. Several randomized clinical trials have established that both long-term overall and, moreover, disease-free survivals are similar after adjuvant and neoadjuvant chemotherapies (NAC) [1]. The reported overall and disease-free survival for patients who achieved a complete pathological response (pCR) were 75% and 85% respectively, at a median follow-up of nine years, compared to 58% and 73% for patients with residual disease [2]. Regular monitoring of tumor response during neoadjuvant therapy is very critical to evaluate the patient’s progress. When the patient’s tumor is progressing despite treatment, neoadjuvant therapy has to be discontinued, and prompt referral to surgery or preoperative radiation therapy is necessary [1]. In clinical trials of patients subjected to neoadjuvant chemotherapy, pCR ranged from 6–26% [3]. In contrast, it appears that pCR infrequently occurs with patients treated with neoadjuvant endocrine therapy [3]. The reported rates of pCR for endocrine treatment (tamoxifen and letrozole) ranges from <1.0% to 6.5% [3]. Clinical response does not seem to be a good surrogate marker for pCR, as only 22% of patients with clinical response achieved pCR [4].

Keywords

Neoadjuvant therapy Pathologic response Residual tumor Pathology reporting 

References

  1. 1.
    Pusztai L. Preoperative systemic chemotherapy and pathologic assessment of response. Pathol Oncol Res. 2008;14(2):169–71.CrossRefPubMedGoogle Scholar
  2. 2.
    Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. 2001;30:96–102.CrossRefGoogle Scholar
  3. 3.
    Tan MC, Al Mushawah F, Gao F, Aft RL, Gillanders WE, Eberlein TJ, et al. Predictors of complete pathological response after neoadjuvant systemic therapy for breast cancer. Am J Surg. 2009;198(4):520–5.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Nahleh Z, Sivasubramaniam D, Dhaliwal S, Sundarajan V, Komrokji R. Residual cancer burden in locally advanced breast cancer: a superior tool. Curr Oncol. 2008;15(6):271–8.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Jiralerspong S, Palla SL, Giordano SH, Meric-Bernstam F, Liedtke C, Barnett CM, et al. Metformin and pathologic complete responses to neoadjuvant chemotherapy in diabetic patients with breast cancer. J Clin Oncol. 2009;27(20):3297–302.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Jacquillat C, Weil M, Baillet F, Borel C, Auclerc G, de Maublanc MA, et al. Results of neoadjuvant chemotherapy and radiation therapy in the breast-conserving treatment of 250 patients with all stages of infiltrative breast cancer. Cancer. 1990;66(1):119–29.CrossRefPubMedGoogle Scholar
  7. 7.
    Kuerer HM, Newman LA, Smith TL, Ames FC, Hunt KK, Dhingra K, et al. Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol. 1999;17(2):460–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Kim TH, Kang DK, Kim JY, Han S, Jung Y. Histologic grade and decrease in tumor dimensions affect axillary lymph node status after neoadjuvant chemotherapy in breast cancer patients. J Breast Cancer. 2015;18(4):394–9.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Rouzier R, Extra JM, Klijanienko J, Falcou MC, Asselain B, Vincent-Salomon A, et al. Incidence and prognostic significance of complete axillary downstaging after primary chemotherapy in breast cancer patients with T1 to T3 tumors and cytologically proven axillary metastatic lymph nodes. J Clin Oncol. 2002;20(5):1304–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Masood S. Neoadjuvant chemotherapy in breast cancers. Womens Health (Lond). 2016;12(5):480–91.CrossRefGoogle Scholar
  11. 11.
    Sahoo S, Lester SC. Pathology of breast carcinomas after neoadjuvant chemotherapy: an overview with recommendations on specimen processing and reporting. Arch Pathol Lab Med. 2009;133(4):633–42.PubMedGoogle Scholar
  12. 12.
    Alvarado-Cabrero I, Alderete-Vázquez G, Quintal-Ramírez M, Patiño M, Ruíz E. Incidence of pathologic complete response in women treated with preoperative chemotherapy for locally advanced breast cancer: correlation of histology, hormone receptor status, Her2/Neu, and gross pathologic findings. Ann Diagn Pathol. 2009;13(3):151–7.CrossRefPubMedGoogle Scholar
  13. 13.
    von Minckwitz G, Untch M, Blohmer JU, Costa SD, Eidtmann H, Fasching PA, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30(15):1796–804.CrossRefGoogle Scholar
  14. 14.
    Castaneda CA, Flores R, Rojas K, Flores C, Castillo M, Milla E. Association between mammographic features and response to neoadjuvant chemotherapy in locally advanced breast carcinoma. Hematol Oncol Stem Cell Ther. 2014;7(4):149–56.CrossRefPubMedGoogle Scholar
  15. 15.
    Wang J, Buchholz TA, Middleton LP, Allred DC, Tucker SL, Kuerer HM, et al. Assessment of histologic features and expression of biomarkers in predicting pathologic response to anthracycline-based neoadjuvant chemotherapy in patients with breast carcinoma. Cancer. 2002;94(12):3107–14.CrossRefPubMedGoogle Scholar
  16. 16.
    Mathew J, Asgeirsson KS, Cheung KL, Chan S, Dahda A, Robertson JF. Neoadjuvant chemotherapy for locally advanced breast cancer: a review of the literature and future directions. Eur J Surg Oncol. 2009;35(2):113–22.CrossRefPubMedGoogle Scholar
  17. 17.
    Pu RT, Schott AF, Sturtz DE, Griffith KA, Kleer CG. Pathologic features of breast cancer associated with complete response to neoadjuvant chemotherapy: importance of tumor necrosis. Am J Surg Pathol. 2005;29(3):354–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Szentmartoni G, Tokes AM, Tokes T, Somlai K, Szasz AM, Torgyík L, et al. Morphological and pathological response in primary systemic therapy of patients with breast cancer and the prediction of disease free survival: a single center observational study. Croat Med J. 2016;57(2):131–9.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Fangberget A, Nilsen LB, Hole KH, Holmen MM, Engebraaten O, Naume B, et al. Neoadjuvant chemotherapy in breast cancer-response evaluation and prediction of response to treatment using dynamic contrast-enhanced and diffusion-weighted MR imaging. Eur Radiol. 2011;21(6):1188–99.CrossRefPubMedGoogle Scholar
  20. 20.
    Gianni L, Eiermann W, Semiglazov V, Manikhas A, Lluch A, Tjulandin S, et al. Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet. 2010;375(9712):377–84.CrossRefPubMedGoogle Scholar
  21. 21.
    Marchio C, Maletta F, Annaratone L, Sapino A. The perfect pathology report after neoadjuvant therapy. J Natl Cancer Inst Monogr. 2015;2015(51):47–50.CrossRefPubMedGoogle Scholar
  22. 22.
    Tubiana-Hulin M, Stevens D, Lasry S, Guinebretière JM, Bouita L, Cohen-Solal C, et al. Response to neoadjuvant chemotherapy in lobular and ductal breast carcinomas: a retrospective study on 860 patients from one institution. Ann Oncol. 2006;17(8):1228–33.CrossRefPubMedGoogle Scholar
  23. 23.
    Peintinger F, Kuerer HM, Anderson K, Boughey JC, Meric-Bernstam F, Singletary SE, et al. Accuracy of the combination of mammography and sonography in predicting tumor response in breast cancer patients after neoadjuvant chemotherapy. Ann Surg Oncol. 2006;13(11):1443–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Sahoo S, Lester SC. Pathology considerations in patients treated with neoadjuvant chemotherapy. Surg Pathol Clin. 2012;5(3):749–74.CrossRefPubMedGoogle Scholar
  25. 25.
    Rajan R, Esteva FJ, Symmans WF. Pathologic changes in breast cancer following neoadjuvant chemotherapy: implications for the assessment of response. Clin Breast Cancer. 2004;5(3):235–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Rajan R, Poniecka A, Smith TL, Yang Y, Frye D, Pusztai L, et al. Change in tumor cellularity of breast carcinoma after neoadjuvant chemotherapy as a variable in the pathologic assessment of response. Cancer. 2004;100(7):1365–73.CrossRefPubMedGoogle Scholar
  27. 27.
    Symmans WF, Peintinger F, Hatzis C, Rajan R, Kuerer H, Valero V, et al. Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol. 2007;25(28):4414–22.CrossRefPubMedGoogle Scholar
  28. 28.
    Corben AD, Abi-Raad R, Popa I, Teo CH, Macklin EA, Koerner FC, et al. Pathologic response and long-term follow-up in breast cancer patients treated with neoadjuvant chemotherapy: a comparison between classifications and their practical application. Arch Pathol Lab Med. 2013;137(8):1074–82.CrossRefPubMedGoogle Scholar
  29. 29.
    Ogston KN, Miller ID, Payne S, Hutcheon AW, Sarkar TK, Smith I, et al. A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival. Breast. 2003;12(5):320–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Sataloff DM, Mason BA, Prestipino AJ, Seinige UL, Lieber CP, Baloch Z. Pathologic response to induction chemotherapy in locally advanced carcinoma of the breast: a determinant of outcome. J Am Coll Surg. 1995;180(3):297–306.PubMedGoogle Scholar
  31. 31.
    Chevallier B, Roche H, Olivier JP, Chollet P, Hurteloup P. Inflammatory breast cancer. Pilot study of intensive induction chemotherapy (FEC-HD) results in a high histologic response rate. Am J Clin Oncol. 1993;16(3):223–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Rouzier R, Pusztai L, Delaloge S, Gonzalez-Angulo AM, Andre F, Hess KR, et al. Nomograms to predict pathologic complete response and metastasis-free survival after preoperative chemotherapy for breast cancer. J Clin Oncol. 2005;23(33):8331–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pathology and Laboratory MedicineMayo ClinicJacksonvilleUSA

Personalised recommendations