- Email: [email protected]
Neoadjuvant Trastuzumab in HER2+ early breast cancer patients – one clinic experience
The Breast 32S1 (2017) S78–S132
Contents lists available at ScienceDirect
The Breast j o u r n a l h o m e p a g e : w w w. e l s e v i e r . c o m / b r st
Poster Abstracts II Neoadjuvant ( pre-operative) Therapy P165 Neoadjuvant Trastuzumab in HER2+ early breast cancer patients – one clinic experience L. Petruzelka1, Z. Bielcikova1 *, M. Zimovjanova1, P. Tesarova1, J. Pribylova1, K. Hejduk2, R. Chloupkova2. 1General Faculty Hospital, First Faculty of Medicine, Charles University in Prague, 2Masaryk University, Institute of Biostatistics and Analysis Background: Trastuzumab is standard of care in patients with HER2+ early breast cancer from 2006 in the Czech Republic. Until the introduction of a new therapeutic standard (trastuzumab + pertuzumab) we present results of neoadjuvant administration of transtuzumab in patients treated in oncology clinic of General Faculty Hospital in Prague. Patients and Methods: We assessed data from breast cancer patients treated mostly with sequential anthracycline-taxane-based chemotherapy in combination with trastuzumab in neoadjuvant setting who finished the therapy before 10th October 2016. Clinicopathological characteristics were worked before and after completion of the treatment. According the type of neoadjuvant therapy we distinguished hormonal vs cytotoxic therapy, venous vs subcutaneous application of trastuzumab, according the surgery breast conserving vs ablative surgery. We counted the number of pathologic complete responses ( pCR) and compared it with histologic features of tumors. We have defined pCR as the presence of no invasive or in situ residual carcinoma in the breast tissue and/or lymphatic nodes. We also monitored strategy of adjuvant treatment and its’ completion. We noticed adverse events connected to trastuzumab therapy and also incomplete therapy. In patients with metastatic disease at any time after completion of treatment, we observed the localization of metastases and disease free survival (DFS). The aim of this retrospective analysis was overall survival (OS) analysis in correlation with pCR. The Kaplan- Meier methodology was used for OS interpretation. OS was calculated from the start of neoadjuvant therapy to the patient’s death. Results: 150 patients were recruited from BREAST registry to evaluate the result. The median age before the start of therapy was 51 years (27–77). The most frequent initial stage II had 63.8% of patients, 2 patients had stage IV disease. 12.5% of patients were younger than 36 years. We evaluated clinical benefit rate (SD or PR) in 149/150 patients according to the radiologic examination, one patient progressed during the palliative therapy. The median OS was not reached, 1 year-OS was 97%, 3 years-OS was 89.8%. pCR was observed in 50% of patients (74/148): 26% of patients reached pCR (ypT0) and 24% near-pCR (ypTis). The rest of results we will present in poster contents. Conclusion: Our retrospective analysis confirms a high rate of pCR in HER2 + patients treated with neoadjuvant trastuzumab. Results will be useful for comparison with pertuzumab data in the next time. Disclosure of Interest: No significant relationships.
0960-9776/ $ – see front matter © 2017 Elsevier Ltd. All rights reserved.
P166 Sentinel lymph node mapping in breast cancer after neoadjuvant chemotherapy: a single institution experience W. Salamoun1 *, D. Abi Gerges2, S. Khairallah3, A. Yatim4, M. El-Houkayem1, A. Ibrahim2, R. Khater2. 1Division of Surgical Oncology, Middle East Institute of Health, Bsalim, Lebanon, 2Division of Medical Oncology, Middle East Institute of Health, Bsalim, Lebanon, 3 Department of Pathology, Middle East Institute of Health, Bsalim, Lebanon, 4Department of Nuclear Medicine, Middle East Institute of Health, Bsalim, Lebanon Objective: Neoadjuvant Chemotherapy (NCT) is the standard of care for patients with locally advanced breast cancer (LABC). Its use in operable breast cancer is gaining wider acceptance. Sentinel lymph node mapping (SLNM) is currently the most accurate staging procedure for the axilla. The aim of our study is to assess the accuracy of sentinel node biopsy after neoadjuvant chemotherapy both for operable and locally advanced breast cancer. Methods: Between August 2004 and September 2016, we performed 104 SLNM after NCT. Patients received all chemotherapy cycles before surgery. The procedures were performed by a single surgeon, using dual technique (radioactive tracer and blue dye). Results: All patients were diagnosed by core needle biopsy and had clip placement before NCT. Patients Age: 23–67; Histology of the primary breast cancer: infiltrating ductal carcinoma (IDC): 66; infiltrating lobular carcinoma (ILC): 23; IDC and ILC: 6; Others ( papillary, colloid, tubular): 9. Molecular subtypes: Luminal A and B: 58; HER-2 overexpression: 20; Triple negative: 26. Patients were divided into 3 groups according to axillary statusGroup1: Histologically positive axillary nodes by fine needle aspiration (FNA): 28; Group 2: Clinically palpable and/or radiologically suspicious nodes: 35; Group 3: Unknown axillary status and NCT given for the primary breast cancer: 41. No patient progressed on chemotherapy. Identification rate: 95.2%. SLN negative: 53 (no axillary dissection); SLN positive: 46 (completion axillary dissection except for one patient); SLN not found: 5 (completion ALND); Group 1: SLN not found: 2/28; SLN negative: 11/ 26; SLN positive: 15/26 – Group 2: SLN not found: 1/35; SLN negative: 18/34; SLN positive: 16/34 – Group 3: SLN not found 2/41; SLN negative: 24/39; SLN positive 15/39; The number of sentinel nodes removed – 18 patients: 1 SLN; 27 patients: 2 SLN; 46 patients: 3 SLN; 8 patients: 4 SLN; 5 patients: SLN not found. Patients with SLN positive – macrometastases: 37; micrometastases: 9. Patients with completion axillary lymph node dissection – SLN positive: 45; no other disease: 18; SLN not found: 5; no other disease: 3; of the patients with SLN negative, 30 patients had no residual disease in breast tissue removed. Follow-up: 3–148 months, no axillary recurrence as only site of disease. Conclusion: Sentinel lymph node mapping is an accurate procedure after NCT. It provides an accurate staging and local control of the axilla, while preventing unnecessary complications of axillary node dissection.
Contents lists available at ScienceDirect
The Breast j o u r n a l h o m e p a g e : w w w. e l s e v i e r . c o m / b r st
Poster Abstracts II Neoadjuvant ( pre-operative) Therapy P165 Neoadjuvant Trastuzumab in HER2+ early breast cancer patients – one clinic experience L. Petruzelka1, Z. Bielcikova1 *, M. Zimovjanova1, P. Tesarova1, J. Pribylova1, K. Hejduk2, R. Chloupkova2. 1General Faculty Hospital, First Faculty of Medicine, Charles University in Prague, 2Masaryk University, Institute of Biostatistics and Analysis Background: Trastuzumab is standard of care in patients with HER2+ early breast cancer from 2006 in the Czech Republic. Until the introduction of a new therapeutic standard (trastuzumab + pertuzumab) we present results of neoadjuvant administration of transtuzumab in patients treated in oncology clinic of General Faculty Hospital in Prague. Patients and Methods: We assessed data from breast cancer patients treated mostly with sequential anthracycline-taxane-based chemotherapy in combination with trastuzumab in neoadjuvant setting who finished the therapy before 10th October 2016. Clinicopathological characteristics were worked before and after completion of the treatment. According the type of neoadjuvant therapy we distinguished hormonal vs cytotoxic therapy, venous vs subcutaneous application of trastuzumab, according the surgery breast conserving vs ablative surgery. We counted the number of pathologic complete responses ( pCR) and compared it with histologic features of tumors. We have defined pCR as the presence of no invasive or in situ residual carcinoma in the breast tissue and/or lymphatic nodes. We also monitored strategy of adjuvant treatment and its’ completion. We noticed adverse events connected to trastuzumab therapy and also incomplete therapy. In patients with metastatic disease at any time after completion of treatment, we observed the localization of metastases and disease free survival (DFS). The aim of this retrospective analysis was overall survival (OS) analysis in correlation with pCR. The Kaplan- Meier methodology was used for OS interpretation. OS was calculated from the start of neoadjuvant therapy to the patient’s death. Results: 150 patients were recruited from BREAST registry to evaluate the result. The median age before the start of therapy was 51 years (27–77). The most frequent initial stage II had 63.8% of patients, 2 patients had stage IV disease. 12.5% of patients were younger than 36 years. We evaluated clinical benefit rate (SD or PR) in 149/150 patients according to the radiologic examination, one patient progressed during the palliative therapy. The median OS was not reached, 1 year-OS was 97%, 3 years-OS was 89.8%. pCR was observed in 50% of patients (74/148): 26% of patients reached pCR (ypT0) and 24% near-pCR (ypTis). The rest of results we will present in poster contents. Conclusion: Our retrospective analysis confirms a high rate of pCR in HER2 + patients treated with neoadjuvant trastuzumab. Results will be useful for comparison with pertuzumab data in the next time. Disclosure of Interest: No significant relationships.
0960-9776/ $ – see front matter © 2017 Elsevier Ltd. All rights reserved.
P166 Sentinel lymph node mapping in breast cancer after neoadjuvant chemotherapy: a single institution experience W. Salamoun1 *, D. Abi Gerges2, S. Khairallah3, A. Yatim4, M. El-Houkayem1, A. Ibrahim2, R. Khater2. 1Division of Surgical Oncology, Middle East Institute of Health, Bsalim, Lebanon, 2Division of Medical Oncology, Middle East Institute of Health, Bsalim, Lebanon, 3 Department of Pathology, Middle East Institute of Health, Bsalim, Lebanon, 4Department of Nuclear Medicine, Middle East Institute of Health, Bsalim, Lebanon Objective: Neoadjuvant Chemotherapy (NCT) is the standard of care for patients with locally advanced breast cancer (LABC). Its use in operable breast cancer is gaining wider acceptance. Sentinel lymph node mapping (SLNM) is currently the most accurate staging procedure for the axilla. The aim of our study is to assess the accuracy of sentinel node biopsy after neoadjuvant chemotherapy both for operable and locally advanced breast cancer. Methods: Between August 2004 and September 2016, we performed 104 SLNM after NCT. Patients received all chemotherapy cycles before surgery. The procedures were performed by a single surgeon, using dual technique (radioactive tracer and blue dye). Results: All patients were diagnosed by core needle biopsy and had clip placement before NCT. Patients Age: 23–67; Histology of the primary breast cancer: infiltrating ductal carcinoma (IDC): 66; infiltrating lobular carcinoma (ILC): 23; IDC and ILC: 6; Others ( papillary, colloid, tubular): 9. Molecular subtypes: Luminal A and B: 58; HER-2 overexpression: 20; Triple negative: 26. Patients were divided into 3 groups according to axillary statusGroup1: Histologically positive axillary nodes by fine needle aspiration (FNA): 28; Group 2: Clinically palpable and/or radiologically suspicious nodes: 35; Group 3: Unknown axillary status and NCT given for the primary breast cancer: 41. No patient progressed on chemotherapy. Identification rate: 95.2%. SLN negative: 53 (no axillary dissection); SLN positive: 46 (completion axillary dissection except for one patient); SLN not found: 5 (completion ALND); Group 1: SLN not found: 2/28; SLN negative: 11/ 26; SLN positive: 15/26 – Group 2: SLN not found: 1/35; SLN negative: 18/34; SLN positive: 16/34 – Group 3: SLN not found 2/41; SLN negative: 24/39; SLN positive 15/39; The number of sentinel nodes removed – 18 patients: 1 SLN; 27 patients: 2 SLN; 46 patients: 3 SLN; 8 patients: 4 SLN; 5 patients: SLN not found. Patients with SLN positive – macrometastases: 37; micrometastases: 9. Patients with completion axillary lymph node dissection – SLN positive: 45; no other disease: 18; SLN not found: 5; no other disease: 3; of the patients with SLN negative, 30 patients had no residual disease in breast tissue removed. Follow-up: 3–148 months, no axillary recurrence as only site of disease. Conclusion: Sentinel lymph node mapping is an accurate procedure after NCT. It provides an accurate staging and local control of the axilla, while preventing unnecessary complications of axillary node dissection.