Chemotherapy is more effective in patients with breast cancer not expressing steroid hormone receptors: A study of preoperative treatment

Marco Colleoni, Giuseppe Viale, David Zahrieh, Giancarlo Pruneri, Oreste Gentilini, Paolo Veronesi, Richard D. Gelber, Giuseppe Curigliano, Rosalba Torrisi, Alberto Luini, Mattia Intra, Viviana Galimberti, Giuseppe Renne, Franco Nolè, Giuua Peruzzotti, Aron Goldhirsch

Research output: Contribution to journalReview article

289 Citations (Scopus)

Abstract

Purpose: The purpose of this research was to identify factors predicting response to preoperative chemotherapy. Experimental Design: In a large volume laboratory using standard immunohistochemical methods, we reviewed the pretreatment biopsies and histologic specimens at final surgery of 399 patients with large or locally advanced breast cancer (cT2-T4, N0-2, M0) who were treated with preoperative chemotherapy. The incidence of pathological complete remission and the incidence of node-negative status at final surgery were assessed with respect to initial pathological and clinical findings. Menopausal status, estrogen receptor status, progesterone receptor status [absent (0% of the cells positive) versus expressed], clinical tumor size, histologic grade, Ki-67, Her-2/neu expression, and type and route of chemotherapy were considered. Results: High rates of pathological complete remission were associated with absence of estrogen receptor and progesterone receptor expression (P < 0.0001), and grade 3 (P = 0.001). Significant predictors of node-negative status at surgery were absence of estrogen receptor and progesterone receptor expression (P < 0.0001), clinical tumor size <5 cm (P < 0.001), and use of infusional regimens (P = 0.003). The chance of obtaining pathological complete remission or node-negative status for patients with endocrine nonresponsive tumors compared with those having some estrogen receptor or progesterone receptor expression was 4.22 (95% confidence interval, 2.20-8.09, 33.3% versus 7.5%) and 3.47 (95% confidence interval, 2.09-5.76, 42.9% versus 21.7%), respectively. Despite the significantly higher incidence of pathological complete remission and node-negative status achieved by preoperative chemotherapy for patients with estrogen receptor and progesterone receptor absent disease, the disease-free survival was significantly worse for this cohort compared with the low/positive expression cohort (4-year disease-free survival %: 41% versus 74%; hazard ratio 3.22; 95% confidence interval, 2.28-4.54; P < 0.0001). Conclusions: Response to preoperative chemotherapy is significantly higher for patients with endocrine nonresponsive tumors. New chemotherapy regimens or combinations should be explored in this cohort of patients with poor outcome. For patients with endocrine responsive disease, the role of preoperative endocrine therapies should be studied.

Original languageEnglish (US)
Pages (from-to)6622-6628
Number of pages7
JournalClinical Cancer Research
Volume10
Issue number19
DOIs
StatePublished - Oct 1 2004
Externally publishedYes

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Steroid Receptors
Progesterone Receptors
Estrogen Receptors
Hormones
Breast Neoplasms
Drug Therapy
Confidence Intervals
Disease-Free Survival
Neoplasms
Incidence
Therapeutics
Endocrine System Diseases
Research Design
Biopsy
Research

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Chemotherapy is more effective in patients with breast cancer not expressing steroid hormone receptors : A study of preoperative treatment. / Colleoni, Marco; Viale, Giuseppe; Zahrieh, David; Pruneri, Giancarlo; Gentilini, Oreste; Veronesi, Paolo; Gelber, Richard D.; Curigliano, Giuseppe; Torrisi, Rosalba; Luini, Alberto; Intra, Mattia; Galimberti, Viviana; Renne, Giuseppe; Nolè, Franco; Peruzzotti, Giuua; Goldhirsch, Aron.

In: Clinical Cancer Research, Vol. 10, No. 19, 01.10.2004, p. 6622-6628.

Research output: Contribution to journalReview article

Colleoni, M, Viale, G, Zahrieh, D, Pruneri, G, Gentilini, O, Veronesi, P, Gelber, RD, Curigliano, G, Torrisi, R, Luini, A, Intra, M, Galimberti, V, Renne, G, Nolè, F, Peruzzotti, G & Goldhirsch, A 2004, 'Chemotherapy is more effective in patients with breast cancer not expressing steroid hormone receptors: A study of preoperative treatment', Clinical Cancer Research, vol. 10, no. 19, pp. 6622-6628. https://doi.org/10.1158/1078-0432.CCR-04-0380
Colleoni, Marco ; Viale, Giuseppe ; Zahrieh, David ; Pruneri, Giancarlo ; Gentilini, Oreste ; Veronesi, Paolo ; Gelber, Richard D. ; Curigliano, Giuseppe ; Torrisi, Rosalba ; Luini, Alberto ; Intra, Mattia ; Galimberti, Viviana ; Renne, Giuseppe ; Nolè, Franco ; Peruzzotti, Giuua ; Goldhirsch, Aron. / Chemotherapy is more effective in patients with breast cancer not expressing steroid hormone receptors : A study of preoperative treatment. In: Clinical Cancer Research. 2004 ; Vol. 10, No. 19. pp. 6622-6628.
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abstract = "Purpose: The purpose of this research was to identify factors predicting response to preoperative chemotherapy. Experimental Design: In a large volume laboratory using standard immunohistochemical methods, we reviewed the pretreatment biopsies and histologic specimens at final surgery of 399 patients with large or locally advanced breast cancer (cT2-T4, N0-2, M0) who were treated with preoperative chemotherapy. The incidence of pathological complete remission and the incidence of node-negative status at final surgery were assessed with respect to initial pathological and clinical findings. Menopausal status, estrogen receptor status, progesterone receptor status [absent (0{\%} of the cells positive) versus expressed], clinical tumor size, histologic grade, Ki-67, Her-2/neu expression, and type and route of chemotherapy were considered. Results: High rates of pathological complete remission were associated with absence of estrogen receptor and progesterone receptor expression (P < 0.0001), and grade 3 (P = 0.001). Significant predictors of node-negative status at surgery were absence of estrogen receptor and progesterone receptor expression (P < 0.0001), clinical tumor size <5 cm (P < 0.001), and use of infusional regimens (P = 0.003). The chance of obtaining pathological complete remission or node-negative status for patients with endocrine nonresponsive tumors compared with those having some estrogen receptor or progesterone receptor expression was 4.22 (95{\%} confidence interval, 2.20-8.09, 33.3{\%} versus 7.5{\%}) and 3.47 (95{\%} confidence interval, 2.09-5.76, 42.9{\%} versus 21.7{\%}), respectively. Despite the significantly higher incidence of pathological complete remission and node-negative status achieved by preoperative chemotherapy for patients with estrogen receptor and progesterone receptor absent disease, the disease-free survival was significantly worse for this cohort compared with the low/positive expression cohort (4-year disease-free survival {\%}: 41{\%} versus 74{\%}; hazard ratio 3.22; 95{\%} confidence interval, 2.28-4.54; P < 0.0001). Conclusions: Response to preoperative chemotherapy is significantly higher for patients with endocrine nonresponsive tumors. New chemotherapy regimens or combinations should be explored in this cohort of patients with poor outcome. For patients with endocrine responsive disease, the role of preoperative endocrine therapies should be studied.",
author = "Marco Colleoni and Giuseppe Viale and David Zahrieh and Giancarlo Pruneri and Oreste Gentilini and Paolo Veronesi and Gelber, {Richard D.} and Giuseppe Curigliano and Rosalba Torrisi and Alberto Luini and Mattia Intra and Viviana Galimberti and Giuseppe Renne and Franco Nol{\`e} and Giuua Peruzzotti and Aron Goldhirsch",
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T1 - Chemotherapy is more effective in patients with breast cancer not expressing steroid hormone receptors

T2 - A study of preoperative treatment

AU - Colleoni, Marco

AU - Viale, Giuseppe

AU - Zahrieh, David

AU - Pruneri, Giancarlo

AU - Gentilini, Oreste

AU - Veronesi, Paolo

AU - Gelber, Richard D.

AU - Curigliano, Giuseppe

AU - Torrisi, Rosalba

AU - Luini, Alberto

AU - Intra, Mattia

AU - Galimberti, Viviana

AU - Renne, Giuseppe

AU - Nolè, Franco

AU - Peruzzotti, Giuua

AU - Goldhirsch, Aron

PY - 2004/10/1

Y1 - 2004/10/1

N2 - Purpose: The purpose of this research was to identify factors predicting response to preoperative chemotherapy. Experimental Design: In a large volume laboratory using standard immunohistochemical methods, we reviewed the pretreatment biopsies and histologic specimens at final surgery of 399 patients with large or locally advanced breast cancer (cT2-T4, N0-2, M0) who were treated with preoperative chemotherapy. The incidence of pathological complete remission and the incidence of node-negative status at final surgery were assessed with respect to initial pathological and clinical findings. Menopausal status, estrogen receptor status, progesterone receptor status [absent (0% of the cells positive) versus expressed], clinical tumor size, histologic grade, Ki-67, Her-2/neu expression, and type and route of chemotherapy were considered. Results: High rates of pathological complete remission were associated with absence of estrogen receptor and progesterone receptor expression (P < 0.0001), and grade 3 (P = 0.001). Significant predictors of node-negative status at surgery were absence of estrogen receptor and progesterone receptor expression (P < 0.0001), clinical tumor size <5 cm (P < 0.001), and use of infusional regimens (P = 0.003). The chance of obtaining pathological complete remission or node-negative status for patients with endocrine nonresponsive tumors compared with those having some estrogen receptor or progesterone receptor expression was 4.22 (95% confidence interval, 2.20-8.09, 33.3% versus 7.5%) and 3.47 (95% confidence interval, 2.09-5.76, 42.9% versus 21.7%), respectively. Despite the significantly higher incidence of pathological complete remission and node-negative status achieved by preoperative chemotherapy for patients with estrogen receptor and progesterone receptor absent disease, the disease-free survival was significantly worse for this cohort compared with the low/positive expression cohort (4-year disease-free survival %: 41% versus 74%; hazard ratio 3.22; 95% confidence interval, 2.28-4.54; P < 0.0001). Conclusions: Response to preoperative chemotherapy is significantly higher for patients with endocrine nonresponsive tumors. New chemotherapy regimens or combinations should be explored in this cohort of patients with poor outcome. For patients with endocrine responsive disease, the role of preoperative endocrine therapies should be studied.

AB - Purpose: The purpose of this research was to identify factors predicting response to preoperative chemotherapy. Experimental Design: In a large volume laboratory using standard immunohistochemical methods, we reviewed the pretreatment biopsies and histologic specimens at final surgery of 399 patients with large or locally advanced breast cancer (cT2-T4, N0-2, M0) who were treated with preoperative chemotherapy. The incidence of pathological complete remission and the incidence of node-negative status at final surgery were assessed with respect to initial pathological and clinical findings. Menopausal status, estrogen receptor status, progesterone receptor status [absent (0% of the cells positive) versus expressed], clinical tumor size, histologic grade, Ki-67, Her-2/neu expression, and type and route of chemotherapy were considered. Results: High rates of pathological complete remission were associated with absence of estrogen receptor and progesterone receptor expression (P < 0.0001), and grade 3 (P = 0.001). Significant predictors of node-negative status at surgery were absence of estrogen receptor and progesterone receptor expression (P < 0.0001), clinical tumor size <5 cm (P < 0.001), and use of infusional regimens (P = 0.003). The chance of obtaining pathological complete remission or node-negative status for patients with endocrine nonresponsive tumors compared with those having some estrogen receptor or progesterone receptor expression was 4.22 (95% confidence interval, 2.20-8.09, 33.3% versus 7.5%) and 3.47 (95% confidence interval, 2.09-5.76, 42.9% versus 21.7%), respectively. Despite the significantly higher incidence of pathological complete remission and node-negative status achieved by preoperative chemotherapy for patients with estrogen receptor and progesterone receptor absent disease, the disease-free survival was significantly worse for this cohort compared with the low/positive expression cohort (4-year disease-free survival %: 41% versus 74%; hazard ratio 3.22; 95% confidence interval, 2.28-4.54; P < 0.0001). Conclusions: Response to preoperative chemotherapy is significantly higher for patients with endocrine nonresponsive tumors. New chemotherapy regimens or combinations should be explored in this cohort of patients with poor outcome. For patients with endocrine responsive disease, the role of preoperative endocrine therapies should be studied.

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