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Pathological response and circulating tumor cell count identifies treated HER2+ inflammatory breast cancer patients with excellent prognosis: BEVERLY-2 survival data.

AbstractPURPOSE:
The BEVERLY-2 single-arm phase II trial assessed the efficacy and safety of combining neoadjuvant chemotherapy with bevacizumab and trastuzumab for the treatment of HER2-positive inflammatory breast cancer (IBC). Here, we report the results of a preplanned survival analysis at 3 years of follow-up, along with the association between outcome and circulating biomarkers and pathologic complete response (pCR).
EXPERIMENTAL DESIGN:
Patients received fluorouracil, epirubicin, cyclophosphamide, and bevacizumab (cycles 1-4) and docetaxel, trastuzumab, and bevacizumab (cycles 5-8) before surgery, followed by trastuzumab and bevacizumab for 30 weeks after surgery. Circulating tumor cell (CTC) and endothelial cell (CEC) counts were assessed at baseline, cycle 5, preoperative, postoperative, and at 1 year.
RESULTS:
Fifty-two patients were included. The 3-year disease-free survival (DFS) rate was 68% and overall survival (OS) rate was 90%. pCR (centrally reviewed) was strongly associated with 3-year DFS [80% and 53% in patients with/without pCR, respectively (P = 0.03)]. CTC detection also independently predicted 3-year DFS [81% vs. 43% for patients with <1 vs. ≥1 CTC/7.5 mL at baseline (P = 0.01)]. Patients with no CTCs detected at baseline and with pCR had a high 3-year DFS (95%). CEC changes during treatment had no prognostic value.
CONCLUSIONS:
Our study suggests that the prognosis of IBC relies on more than the achievement of pCR and highlights the role of early hematogenous tumor dissemination as assessed by CTCs. Combining these two prognostic factors isolates a subgroup of IBC with excellent survival when treated with bevacizumab- and trastuzumab-containing regimens.
AuthorsJean-Yves Pierga, Thierry Petit, Christelle Lévy, Jean-Marc Ferrero, Mario Campone, Joseph Gligorov, Florence Lerebours, Henri Roché, Thomas Bachelot, Emmanuelle Charafe-Jauffret, Jacques Bonneterre, Juana Hernandez, François-Clément Bidard, Patrice Viens
JournalClinical cancer research : an official journal of the American Association for Cancer Research (Clin Cancer Res) Vol. 21 Issue 6 Pg. 1298-304 (Mar 15 2015) ISSN: 1557-3265 [Electronic] United States
PMID25538259 (Publication Type: Clinical Trial, Phase II, Journal Article, Research Support, Non-U.S. Gov't)
Copyright©2014 American Association for Cancer Research.
Chemical References
  • Angiogenesis Inhibitors
  • Antineoplastic Agents
  • Biomarkers, Tumor
  • Taxoids
  • Docetaxel
  • Bevacizumab
  • Epirubicin
  • Cyclophosphamide
  • ERBB2 protein, human
  • Receptor, ErbB-2
  • Trastuzumab
  • Fluorouracil
Topics
  • Angiogenesis Inhibitors (therapeutic use)
  • Antineoplastic Agents (therapeutic use)
  • Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
  • Bevacizumab (therapeutic use)
  • Biomarkers, Tumor (blood)
  • Cyclophosphamide (therapeutic use)
  • Docetaxel
  • Epirubicin (therapeutic use)
  • Female
  • Fluorouracil (therapeutic use)
  • Humans
  • Inflammatory Breast Neoplasms (drug therapy, mortality, surgery)
  • Middle Aged
  • Neoadjuvant Therapy
  • Neoplastic Cells, Circulating (drug effects)
  • Prognosis
  • Receptor, ErbB-2 (metabolism)
  • Survival Rate
  • Taxoids (therapeutic use)
  • Trastuzumab (therapeutic use)

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