Tumor Biology and Response to Chemotherapy Impact Breast Cancer-specific Survival in Node-positive Breast Cancer Patients Treated With Neoadjuvant Chemotherapy: Long-term Follow-up From ACOSOG Z1071 (Alliance)

Judy C Boughey, Karla V. Ballman, Linda M. McCall, Elizabeth A. Mittendorf, William Fraser Symmans, Thomas B. Julian, David Byrd, Kelly K. Hunt

Research output: Contribution to journalArticle

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Abstract

BACKGROUND:: Women with node-positive breast cancer are at high risk for recurrence. We evaluate the impact of approximated tumor subtype and response to chemotherapy on long-term outcomes in a node-positive cohort receiving neoadjuvant chemotherapy. METHODS:: ACOSOG Z1071 enrolled cT0-4N1-2 breast cancer patients treated with neoadjuvant chemotherapy from 2009 to 2011. Factors impacting breast cancer-specific survival (BCSS) and overall survival (OS) were analyzed. RESULTS:: Median follow-up of 701 eligible patients was 4.1 years (0.4–6.5). Ninety patients (12.8%) died from breast cancer. Approximated subtype and chemotherapy response were significantly associated with BCSS and OS (P < 0.0001). BCSS and OS were highest in patients who achieved pathologic complete response (pCR) (P < 0.0001 and P < 0.0001, respectively).Five-year BCSS was highest in human epidermal growth factor receptor 2 (HER2)-positive disease [95.8%; 95% confidence interval (CI): 87.7–98.6], followed by hormone receptor-positive/HER2-negative (80.4%; 95% CI: 73.2–85.9) and lowest in triple-negative (TNBC) (74.8%; 95% CI: 66.6–81.2; P < 0.0001). Similar patterns were seen in OS.In TNBC (n = 174), 5-year BCSS was higher in patients with pCR versus residual disease (89.8%; 95% CI: 78.8–95.3 vs 65.8%; 95% CI: 54.5–74.9; P = 0.0013). In hormone receptor-positive/HER2-negative (n = 318) disease, BCSS was 100% in patients with pCR and 78.3% (95% CI: 70.4–84.3) in those with residual disease (P = 0.018). In HER2-positive disease (n = 204) there was no difference between pCR and residual disease (96.0%; 95% CI: 83.6–99.1 vs 95.8%; 95% CI: 81.4–99.1; P = 0.77). CONCLUSIONS:: In node-positive breast cancer patients treated with neoadjuvant chemotherapy, BCSS and OS were associated with approximated subtype and chemotherapy response and were lowest in TNBC patients with residual disease. Five-year BCSS was > 95% in HER2-positive disease independent of chemotherapy response.

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - Jun 27 2017

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Breast Neoplasms
Drug Therapy
Survival
Neoplasms
Recurrence

ASJC Scopus subject areas

  • Surgery

Cite this

Tumor Biology and Response to Chemotherapy Impact Breast Cancer-specific Survival in Node-positive Breast Cancer Patients Treated With Neoadjuvant Chemotherapy : Long-term Follow-up From ACOSOG Z1071 (Alliance). / Boughey, Judy C; Ballman, Karla V.; McCall, Linda M.; Mittendorf, Elizabeth A.; Symmans, William Fraser; Julian, Thomas B.; Byrd, David; Hunt, Kelly K.

In: Annals of Surgery, 27.06.2017.

Research output: Contribution to journalArticle

@article{74c4dd290d8e441c841a66e31a44e1ba,
title = "Tumor Biology and Response to Chemotherapy Impact Breast Cancer-specific Survival in Node-positive Breast Cancer Patients Treated With Neoadjuvant Chemotherapy: Long-term Follow-up From ACOSOG Z1071 (Alliance)",
abstract = "BACKGROUND:: Women with node-positive breast cancer are at high risk for recurrence. We evaluate the impact of approximated tumor subtype and response to chemotherapy on long-term outcomes in a node-positive cohort receiving neoadjuvant chemotherapy. METHODS:: ACOSOG Z1071 enrolled cT0-4N1-2 breast cancer patients treated with neoadjuvant chemotherapy from 2009 to 2011. Factors impacting breast cancer-specific survival (BCSS) and overall survival (OS) were analyzed. RESULTS:: Median follow-up of 701 eligible patients was 4.1 years (0.4–6.5). Ninety patients (12.8{\%}) died from breast cancer. Approximated subtype and chemotherapy response were significantly associated with BCSS and OS (P < 0.0001). BCSS and OS were highest in patients who achieved pathologic complete response (pCR) (P < 0.0001 and P < 0.0001, respectively).Five-year BCSS was highest in human epidermal growth factor receptor 2 (HER2)-positive disease [95.8{\%}; 95{\%} confidence interval (CI): 87.7–98.6], followed by hormone receptor-positive/HER2-negative (80.4{\%}; 95{\%} CI: 73.2–85.9) and lowest in triple-negative (TNBC) (74.8{\%}; 95{\%} CI: 66.6–81.2; P < 0.0001). Similar patterns were seen in OS.In TNBC (n = 174), 5-year BCSS was higher in patients with pCR versus residual disease (89.8{\%}; 95{\%} CI: 78.8–95.3 vs 65.8{\%}; 95{\%} CI: 54.5–74.9; P = 0.0013). In hormone receptor-positive/HER2-negative (n = 318) disease, BCSS was 100{\%} in patients with pCR and 78.3{\%} (95{\%} CI: 70.4–84.3) in those with residual disease (P = 0.018). In HER2-positive disease (n = 204) there was no difference between pCR and residual disease (96.0{\%}; 95{\%} CI: 83.6–99.1 vs 95.8{\%}; 95{\%} CI: 81.4–99.1; P = 0.77). CONCLUSIONS:: In node-positive breast cancer patients treated with neoadjuvant chemotherapy, BCSS and OS were associated with approximated subtype and chemotherapy response and were lowest in TNBC patients with residual disease. Five-year BCSS was > 95{\%} in HER2-positive disease independent of chemotherapy response.",
author = "Boughey, {Judy C} and Ballman, {Karla V.} and McCall, {Linda M.} and Mittendorf, {Elizabeth A.} and Symmans, {William Fraser} and Julian, {Thomas B.} and David Byrd and Hunt, {Kelly K.}",
year = "2017",
month = "6",
day = "27",
doi = "10.1097/SLA.0000000000002373",
language = "English (US)",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",

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TY - JOUR

T1 - Tumor Biology and Response to Chemotherapy Impact Breast Cancer-specific Survival in Node-positive Breast Cancer Patients Treated With Neoadjuvant Chemotherapy

T2 - Long-term Follow-up From ACOSOG Z1071 (Alliance)

AU - Boughey, Judy C

AU - Ballman, Karla V.

AU - McCall, Linda M.

AU - Mittendorf, Elizabeth A.

AU - Symmans, William Fraser

AU - Julian, Thomas B.

AU - Byrd, David

AU - Hunt, Kelly K.

PY - 2017/6/27

Y1 - 2017/6/27

N2 - BACKGROUND:: Women with node-positive breast cancer are at high risk for recurrence. We evaluate the impact of approximated tumor subtype and response to chemotherapy on long-term outcomes in a node-positive cohort receiving neoadjuvant chemotherapy. METHODS:: ACOSOG Z1071 enrolled cT0-4N1-2 breast cancer patients treated with neoadjuvant chemotherapy from 2009 to 2011. Factors impacting breast cancer-specific survival (BCSS) and overall survival (OS) were analyzed. RESULTS:: Median follow-up of 701 eligible patients was 4.1 years (0.4–6.5). Ninety patients (12.8%) died from breast cancer. Approximated subtype and chemotherapy response were significantly associated with BCSS and OS (P < 0.0001). BCSS and OS were highest in patients who achieved pathologic complete response (pCR) (P < 0.0001 and P < 0.0001, respectively).Five-year BCSS was highest in human epidermal growth factor receptor 2 (HER2)-positive disease [95.8%; 95% confidence interval (CI): 87.7–98.6], followed by hormone receptor-positive/HER2-negative (80.4%; 95% CI: 73.2–85.9) and lowest in triple-negative (TNBC) (74.8%; 95% CI: 66.6–81.2; P < 0.0001). Similar patterns were seen in OS.In TNBC (n = 174), 5-year BCSS was higher in patients with pCR versus residual disease (89.8%; 95% CI: 78.8–95.3 vs 65.8%; 95% CI: 54.5–74.9; P = 0.0013). In hormone receptor-positive/HER2-negative (n = 318) disease, BCSS was 100% in patients with pCR and 78.3% (95% CI: 70.4–84.3) in those with residual disease (P = 0.018). In HER2-positive disease (n = 204) there was no difference between pCR and residual disease (96.0%; 95% CI: 83.6–99.1 vs 95.8%; 95% CI: 81.4–99.1; P = 0.77). CONCLUSIONS:: In node-positive breast cancer patients treated with neoadjuvant chemotherapy, BCSS and OS were associated with approximated subtype and chemotherapy response and were lowest in TNBC patients with residual disease. Five-year BCSS was > 95% in HER2-positive disease independent of chemotherapy response.

AB - BACKGROUND:: Women with node-positive breast cancer are at high risk for recurrence. We evaluate the impact of approximated tumor subtype and response to chemotherapy on long-term outcomes in a node-positive cohort receiving neoadjuvant chemotherapy. METHODS:: ACOSOG Z1071 enrolled cT0-4N1-2 breast cancer patients treated with neoadjuvant chemotherapy from 2009 to 2011. Factors impacting breast cancer-specific survival (BCSS) and overall survival (OS) were analyzed. RESULTS:: Median follow-up of 701 eligible patients was 4.1 years (0.4–6.5). Ninety patients (12.8%) died from breast cancer. Approximated subtype and chemotherapy response were significantly associated with BCSS and OS (P < 0.0001). BCSS and OS were highest in patients who achieved pathologic complete response (pCR) (P < 0.0001 and P < 0.0001, respectively).Five-year BCSS was highest in human epidermal growth factor receptor 2 (HER2)-positive disease [95.8%; 95% confidence interval (CI): 87.7–98.6], followed by hormone receptor-positive/HER2-negative (80.4%; 95% CI: 73.2–85.9) and lowest in triple-negative (TNBC) (74.8%; 95% CI: 66.6–81.2; P < 0.0001). Similar patterns were seen in OS.In TNBC (n = 174), 5-year BCSS was higher in patients with pCR versus residual disease (89.8%; 95% CI: 78.8–95.3 vs 65.8%; 95% CI: 54.5–74.9; P = 0.0013). In hormone receptor-positive/HER2-negative (n = 318) disease, BCSS was 100% in patients with pCR and 78.3% (95% CI: 70.4–84.3) in those with residual disease (P = 0.018). In HER2-positive disease (n = 204) there was no difference between pCR and residual disease (96.0%; 95% CI: 83.6–99.1 vs 95.8%; 95% CI: 81.4–99.1; P = 0.77). CONCLUSIONS:: In node-positive breast cancer patients treated with neoadjuvant chemotherapy, BCSS and OS were associated with approximated subtype and chemotherapy response and were lowest in TNBC patients with residual disease. Five-year BCSS was > 95% in HER2-positive disease independent of chemotherapy response.

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U2 - 10.1097/SLA.0000000000002373

DO - 10.1097/SLA.0000000000002373

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JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

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