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Pathological Complete Response and Prognosis

Posted 9/13/2014

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  This is a fairly geeky entry that likely will hold enormous interest for some of you and little for most others. To decode the title: "Pathological Complete Response" (pCR) means that no cancer is seen in the specimen/pathology report from surgery after neoadjuvant chemotherapy. As you likely know, neoadjuvant chemotherapy is treatment that is given before definitive breast cancer surgery, after only a biopsy. This is the choice when a cancer is especially nasty, and the goal is to start treating it ASAP or when the tumor is large, and the hope is to shrink it so that a lumpectomy, rather than a mastectomy, will be possible.

  For some time, the thought has been that having a pCR brought a better prognosis than finding cancer still in the breast after chemotherapy. The importance of this study is that it fine-tuned that observation, distinguishing between the biology of different cancers. This clearly is the whole wave of the future as more and more is understood about individual cells and the differences among them.

  From Medscape comes this report. I give you this start and then a link:

Does pCR Point to Improved Survival in Breast Cancer?

Lidia Schapira, MD

Study Summary

Prior studies have shown that achieving a pathologic complete response (pCR) after neoadjuvant chemotherapy was associated with improvement in event-free survival and overall survival (OS). The NeoALTTO investigators previously reported that dual HER2 blockade using trastuzumab and lapatinib with paclitaxel chemotherapy led to higher rates of pCR than trastuzumab alone.[1] Here, de Azambuja and colleagues describe results of prespecified secondary outcomes of OS and the association between pCR and OS.

In the study, women with HER2-positive (HER2+) early breast cancer were randomly assigned to receive oral lapatinib (1500 mg), intravenous trastuzumab (4 mg/kg loading dose, followed by 2 mg/kg), or lapatinib (1000 mg) plus trastuzumab (same dose as for single agent) in combination for six weeks, followed by an additional 12 weeks of the assigned anti-HER2 therapy in combination with weekly paclitaxel (80 mg/m2). Definitive surgery was done four weeks after the last dose of paclitaxel. After surgery, women received three cycles of FEC (fluorouracil 500 mg/m2 plus epirubicin 100 mg/m2 plus cyclophosphamide 500 mg/m2) given intravenously every three weeks, followed by 34 weeks of the same assigned neoadjuvant anti-HER2 therapy.

The primary endpoint was pCR. Secondary endpoints included event-free survival and OS, and the association between pCR and event-free survival or OS.


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