Impact of neoadjuvant chemotherapy in stage II-III triple negative breast cancer on eligibility for breast-conserving surgery and breast conservation rates: surgical results from CALGB 40603 (Alliance).

Abstract

OBJECTIVE:

To assess the efficacy of neoadjuvant systemic therapy (NST) at increasing the rate of successful breast-conserving therapy (BCT) in triple negative breast cancer.

BACKGROUND:

Inducing tumor regression to permit BCT is often cited to support administration of NST. To quantify this benefit, we conducted a surgical companion study to CALGB40603, a randomized phase II, 2×2 factorial trial of neoadjuvant paclitaxel ± carboplatin ± bevacizumab (B) followed by doxorubicin plus cyclophosphamide ± B in stage II-III triple negative breast cancer.

METHODS:

Before and after NST, treating surgeons evaluated BCT candidacy by clinico-radiographic criteria; surgery performed was at surgeon and patient discretion. We measured (1) conversion rates from BCT-ineligible to BCT-eligible, (2) surgical choices in BCT candidates, and (3) rates of successful BCT with tumor-free margins.

RESULTS:

Four hundred four patients were assessable for surgical outcomes. Two hundred nineteen (54%) were BCT candidates before NST. One hundred ninety-seven (90%) remained BCT candidates after NST, of whom 138 (70%) chose BCT, which was successful in 130 (94%). Of 185 (46%) who were not BCT candidates before NST, 78 (42%) converted to candidates with NST. Of these, 53 (68%) chose BCT with a 91% (48/53) success rate. The overall BCT-eligibility rate rose from 54% to 68% (275/404) with NST. Addition of carboplatin, B, or both increased conversion rates.

CONCLUSIONS:

This is the first study to document prospectively a 42% conversion rate from BCT-ineligible to BCT-eligible, resulting in a 14% absolute increase in BCT eligibility. BCT was successful in 93% of patients who opted for it, but 31% of BCT-eligible patients still chose mastectomy.

• Authors: Mehra Golshan, Constance T Cirrincione, William M Sikov, Donald A Berry, Sara Jasinski, Tracey F Weisberg, George Somlo, Clifford Hudis, Eric Winer, David W Ollila, Alliance for Clinical Trials in Oncology
• Journal: Annals of surgery (Ann Surg) Vol. 262 Issue 3 Pg. 434-9; discussion 438-9 (Sep 2015) ISSN: 1528-1140 [Electronic] United States
• PMID: 26222764 (Publication Type: Clinical Trial, Phase II, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal, Humanized
• Bevacizumab
• Doxorubicin
• Carboplatin
• Paclitaxel

Topics

• Adult
• Aged
• Antibodies, Monoclonal, Humanized (administration & dosage, adverse effects)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Bevacizumab
• Carboplatin (administration & dosage, adverse effects)
• Chemotherapy, Adjuvant
• Disease-Free Survival
• Doxorubicin (administration & dosage, adverse effects)
• Female
• Humans
• Mastectomy, Segmental (methods)
• Maximum Tolerated Dose
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Invasiveness (pathology)
• Neoplasm Staging
• Paclitaxel (administration & dosage, adverse effects)
• Patient Selection
• Prognosis
• Prospective Studies
• Survival Analysis
• Treatment Outcome
• Triple Negative Breast Neoplasms (mortality, pathology, therapy)
• Young Adult