Preoperative concurrent paclitaxel-radiation in locally advanced breast cancer: pathologic response correlates with five-year overall survival.

Adams S, Chakravarthy AB, Donach M, Spicer D, Lymberis S, Singh B, Bauer JA, Hochman T, Goldberg JD, Muggia F, Schneider RJ, Pietenpol JA, Formenti SC
Breast Cancer Res Treat. 2010 124 (3): 723-32

PMID: 20878462 · PMCID: PMC3655407 · DOI:10.1007/s10549-010-1181-8

We have previously demonstrated high pathologic response rates after neoadjuvant concurrent chemoradiation in patients with locally advanced breast cancer (LABC). We now report disease-free survival (DFS) and overall survival (OS) in the context of pathologic response. 105 LABC patients (White 46%, Non-White 54%) were treated with paclitaxel (30 mg/m² intravenously twice a week) for 10-12 weeks. Daily radiotherapy was delivered to breast, axillary, and supraclavicular lymph nodes during weeks 2-7 of paclitaxel treatment, at 1.8 Gy per fraction to a total dose of 45 Gy with a tumor boost of 14 Gy at 2 Gy/fraction. Pathological complete response (pCR) was defined as the absence of invasive cancer in breast and lymph nodes and pathological partial response (pPR) as the persistence of <10 microscopic foci of invasive carcinoma in breast or lymph nodes. Pathologic response (pCR and pPR) after neoadjuvant chemoradiation was achieved in 36/105 patients (34%) and was associated with significantly better DFS and OS. Pathological responders had a lower risk of recurrence or death (HR = 0.35, P = 0.01) and a longer OS (HR = 4.27, P = 0.01) compared with non-responders. Median DFS and OS were 57 and 84 months for non-responders, respectively, and have not yet been reached for responders. Importantly, pathologic response was achieved in 54% of patients with HR negative tumors (26/48). In conclusion, pathologic response to concurrent paclitaxel-radiation translated into superior DFS and OS. Half of the patients with HR negative tumors achieved a pathologic response.

MeSH Terms (27)

Adult Antineoplastic Agents, Phytogenic Breast Neoplasms Chemotherapy, Adjuvant Chi-Square Distribution Disease-Free Survival Drug Administration Schedule Female Humans Kaplan-Meier Estimate Lymphatic Metastasis Mastectomy Middle Aged Neoadjuvant Therapy Neoplasm Invasiveness Neoplasm Recurrence, Local Neoplasm Staging Paclitaxel Proportional Hazards Models Prospective Studies Radiotherapy, Adjuvant Radiotherapy Dosage Risk Assessment Risk Factors Time Factors Treatment Outcome United States

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