A neoadjuváns kemoterápiára adott patológiai választ kívántuk elemezni az emlőtumorok immunhisztokémiai fenotípusai, valamint az alkalmazott kemoterápiás protokollok tükrében. 1998 és 2009 között 92 neoadjuváns kezelésen átesett emlőtumoros nőbeteg klinikai adatait, biopsziás és műtéti anyagát valamint túlélési mutatóit vizsgáltuk. A biopsziás- és műtéti anyagokon hormonreceptor (ER, PgR), Ki-67, p53, HER2 státusz meghatározás történt immunhisztokémiai módszerrel. A patológiai válasz megítélésére a Chevallier-osztályozást használtuk. 88 esetben elemeztük a betegségmentes- és a teljes túlélést a patológiai válasz függvényében. Patológiai komplett remisszió (pCR = Chevallier I és II) volt kimutatható 13/92 esetben (14,1%). A preoperatív daganatjellemzők alapján a patológiai komplett remissziót mutató daganatok a tripla negatív (9/13) valamint az ER-/HER2+ (1/13) és az ER+/HER2+ (3/13) csoportokból kerültek ki. 24 beteg részesült taxán-, 30 antraciklin-, 33 taxán+antraciklin alapú terápiában, 2 CMF típusú neoadjuváns kezelésben, 3 esetben nem állt rendelkezésünkre ez az adat. A taxánnal kezelt betegek 29,1%-ában, az antraciklin-származékkal kezelt betegek 6,6%-ában, a kombinált kezelésben részesült betegek 12,1%-ában volt kimutatható pCR. A pCR-t mutató csoportban kevesebb volt a recidíva és a távoli áttét kialakulása, de nem tudtunk szignifikáns különbséget igazolni. A kezelésre reagáló (Chevallier III) és a nem reagáló (Chevallier IV) csoport között ebben a tekintetben szignifikáns különbséget találtunk (p=0,006). A betegségspecifikus halálozás szignifikánsan alacsonyabb volt a pCR betegcsoportban (p=0,050). Eredményeink alapján a patológiai komplett remissziót mutató esetek a tripla negatív és a HER2-pozitív csoportból kerültek ki. A neoadjuváns kezelés az ER+/HER2- tumorcsoportban volt a legkevésbé hatékony.
1 Baselga, J, Semiglazov, V, Manikhas, GM et al. 2007 Efficacy of neoadjuvant trastuzumab in patients with inflammatory breast cancer: data from the NOAH (Neoadjuvant Herceptin) phase III trial Eur J Cancer 5 193.
2 Bear, HD, Anderson, S, Brown, A et al. 2003 The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27 J Clin Oncol 21 4165–4174.
3 Bear, HD, Anderson, S, Smith, RE et al. 2006 Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27 J Clin Oncol 24 2019–2027.
4 Buzdar, AU, Valero, V, Ibrahim, NK et al. 2007 Neoadjuvant therapy with paclitaxel followed by 5-fluorouracil, epirubicin, and cyclophosphamide chemotherapy and concurrent trastuzumab in human epidermal growth factor receptor 2-positive operable breast cancer: an update of the initial randomized study population and data of additional patients treated with the same regimen Clin Cancer Res 13 228–233.
5 Capirci, C, Valentini, V, Cionini, L et al. 2008 Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients Int J Radiat Oncol Biol Phys 72 99–107.
6 Carey, LA, Dees, EC, Sawyer, L et al. 2007 The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes Clin Cancer Res 13 2329–2334.
7 Carey, LA, Metzger, R, Dees, EC et al. 2005 American Joint Committee on Cancer tumor-node-metastasis stage after neoadjuvant chemotherapy and breast cancer outcome J Natl Cancer Inst 97 1137–1142.
8 Chevallier, B, Roche, H, Olivier, JP et al. 1993 Inflammatory breast cancer. Pilot study of intensive induction chemotherapy (FEC-HD) results in a high histologic response rate Am J Clin Oncol 16 223–228.
9 Dank, M, Zergenyi, E, Domotori, ZS et al. 2003 Primary systemic therapy (PST) of locally advanced breast cancer using Doxorubicin/Docetaxel combination Anticancer Res 23 2879–2880.
10 Feldman, LD, Hortobagyi, GN, Buzdar, AU et al. 1986 Pathological assessment of response to induction chemotherapy in breast cancer Cancer Res 46 2578–2581.
11 Fisher, B, Bryant, J, Wolmark, N et al. 1998 Effect of preoperative chemotherapy on the outcome of women with operable breast cancer J Clin Oncol 16 2672–2685.
12 Gianni, L, Eiermann, W, Semiglazov, V, et al. Neoadjuvant trastuzumab in patients with her2-positive locally advanced breast cancer: primary efficacy analysis of the noah trial. Presented at the 31st Annual San Antonio Breast Cancer Symposium, 2008 http://www.abstracts2view.com/sabcs/view.php?nu=SABCS08L_1443&terms.
13 Gralow, JR, Burstein, HJ, Wood, W et al. 2008 Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease J Clin Oncol 26 814–819.
14 Guarneri, V, Broglio, K, Kau, SW et al. 2006 Prognostic value of pathologic complete response after primary chemotherapy in relation to hormone receptor status and other factors J Clin Oncol 24 1037–1044.
15 Hammock, L, Lewis, M, Phillips, C et al. 2003 Strong HER-2/neu protein overexpression by immunohistochemistry often does not predict oncogene amplification by fluorescence in situ hybridization Hum Pathol 34 1043–1047.
16 Hayward, JL, Carbone, PP, Heusen, JC et al. 1977 Assessment of response to therapy in advanced breast cancer Br J Cancer 35 292–298.
17 Hennessy, BT, Hortobagyi, GN, Rouzier, R et al. 2005 Outcome after pathologic complete eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy J Clin Oncol 23 9304–9311.
18 Heys, SD, Sarkar, T, Hutcheon, AW 2005 Primary docetaxel chemotherapy in patients with breast cancer: impact on response and survival Breast Cancer Res Treat 90 169–185.
19 Kahán, Zs, Nikolényi, A, Uhercsák, G, Thurzó, L 2009 Neoadjuváns szisztémás terápia emlőrákban Orvosi Hetilap 150 65–71.
20 Kaplan, EL, Meier, P 1958 Nonparametric estimation from incomplete observations J Am Stat Assoc 53 457–481.
21 Kaufmann, M, Minckwitz von, G, Smith, R et al. 2003 International expert panel on the use of primary (preoperative) systemic treatment of operable breast cancer: review and recommendations J Clin Oncol 21 2600–2608.
22 Liedtke, C, Mazouni, C, Hess, KR et al. 2008 Response to neoadjuvant therapy and long term survival in patients with triple-negative breast cancer J Clin Oncol 26 1275–1281.
23 Mamounas, EP 1998 Overview of National Surgical Adjuvant Breast Project neoadjuvant chemotherapy studies Semin Oncol 25 31–35.
24 Mauri, D, Pavlidis, N, Ioannidis, JP 2005 Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis J Natl Cancer Inst 97 188–194.
25 Ogston, KN, Miller, ID, Payne, S et al. 2003 A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival Breast 12 320–327.
26 Peintinger, F, Buzdar, AU, Kuerer, HM et al. 2008 Hormone receptor status and pathologic response of HER2-positive breast cancer treated with neoadjuvant chemotherapy and trastuzumab Ann Oncol 19 2020–2025.
27 Penault-Llorca, F, Abrial, C, Raoelfils, I et al. 2008 Comparison of the prognostic significance of Chevallier and Sataloff’s pathologic classifications after neoadjuvant chemotherapy of operable breast cancer Hum Pathol 39 1221–1228.
28 Pinder, SE, Provenzano, E, Earl, H et al. 2007 Laboratory handling and histology reporting of breast specimens from patients who have received neoadjuvant chemotherapy Histopathology 50 409–417.
29 Pusztai, L 2008 Preoperative systemic chemotherapy and pathologic assessment of response Pathol Oncol Res 14 169–171.
30 Reis-Filho, JS, Tutt, AN 2008 Triple negative tumours: a critical review Histopathology 52 108–118.
31 Ring, AE, Ellis, PA 2002 Predictors of response to systemic therapy in breast cancer Forum (Genova) 12 19–32.
32 Ring, AE, Smith, IE, Ashley, S et al. 2004 Oestrogen receptor status, pathological complete response and prognosis in patients receiving neoadjuvant chemotherapy for early breast cancer Br J Cancer 91 2012–2017.
33 Sanchez-Munoz, A, Garcia-Tapiador, AM, Martinez-Ortega, E et al. 2008 Tumour molecular subtyping according to hormone receptors and HER2 status defines different pathological complete response to neoadjuvant chemotherapy in patients with locally advanced breast cancer Clin Transl Oncol 10 646–653.
34 Sataloff, DM, Mason, BA, Prestipino, AJ et al. 1995 Pathologic response to induction chemotherapy in locally advanced carcinoma of the breast: a determinant of outcome J Am Coll Surg 180 297–306.
35 Straver, ME, Glas, AM, Hannemann, J, et al. The 70-gene signature as a response predictor for neoadjuvant chemotherapy in breast cancer. Breast Cancer Res Treat, 2009.
36 Straver, ME, Adrichem van, JC, Rutgers, EJ et al. 2008 Neoadjuvant systemic therapy in patients with operable primary breast cancer: more benefits than breast-conserving therapy Ned Tijdschr Geneeskd 152 2519–2525.
37 Tokes, AM, Szasz, AM, Farkas, A et al. 2009 Stromal matrix protein expression following preoperative systemic therapy in breast cancer Clin Cancer Res 15 731–739.
38 Wang, S, Yang, H, Tong, F et al. 2009 Response to neoadjuvant therapy and disease free survival in patients with triple-negative breast cancer Gan To Kagaku Ryoho 36 255–258.
39 Wolff, AC, Davidson, NE 2002 Preoperative therapy in breast cancer: lessons from the treatment of locally advanced disease Oncologist 7 239–245.
40 Wolff, AC, Hammond, ME, Schwartz, JN et al. 2007 American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer J Clin Oncol 25 118–145.