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Association of Residual Ductal Carcinoma In Situ With Breast Cancer Recurrence in the Neoadjuvant I-SPY2 Trial.
Osdoit, Marie; Yau, Christina; Symmans, W Fraser; Boughey, Judy C; Ewing, Cheryl A; Balassanian, Ron; Chen, Yunn-Yi; Krings, Gregor; Wallace, Anne M; Zare, Somaye; Fadare, Oluwole; Lancaster, Rachael; Wei, Shi; Godellas, Constantine V; Tang, Ping; Tuttle, Todd M; Klein, Molly; Sahoo, Sunati; Hieken, Tina J; Carter, Jodi M; Chen, Beiyun; Ahrendt, Gretchen; Tchou, Julia; Feldman, Michael; Tousimis, Eleni; Zeck, Jay; Jaskowiak, Nora; Sattar, Husain; Naik, Arpana M; Lee, Marie Catherine; Rosa, Marilin; Khazai, Laila; Rendi, Mara H; Lang, Julie E; Lu, Janice; Tawfik, Ossama; Asare, Smita M; Esserman, Laura J; Mukhtar, Rita A.
Afiliación
  • Osdoit M; Department of Surgery, University of California San Francisco, San Francisco.
  • Yau C; Department of Surgery, University of California San Francisco, San Francisco.
  • Symmans WF; Department of Pathology, University of Texas MD Anderson Cancer Center, Houston.
  • Boughey JC; Department of Surgery, Mayo Clinic, Rochester, Minnesota.
  • Ewing CA; Department of Surgery, University of California San Francisco, San Francisco.
  • Balassanian R; Department of Pathology, University of California San Francisco, San Francisco.
  • Chen YY; Department of Pathology, University of California San Francisco, San Francisco.
  • Krings G; Department of Pathology, University of California San Francisco, San Francisco.
  • Wallace AM; Department of Surgery, University of California San Diego, La Jolla.
  • Zare S; Department of Pathology, University of California San Diego, La Jolla.
  • Fadare O; Department of Pathology, University of California San Diego, La Jolla.
  • Lancaster R; Department of Surgery, University of Alabama at Birmingham, Birmingham.
  • Wei S; Department of Pathology, University of Alabama at Birmingham.
  • Godellas CV; Department of Surgery, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois.
  • Tang P; Department of Pathology, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois.
  • Tuttle TM; Department of Surgery, University of Minnesota, Minneapolis.
  • Klein M; Laboratory Medicine and Pathology, Masonic Cancer Center, Minneapolis, Minnesota.
  • Sahoo S; Department of Pathology, University of Texas Southwestern Medical Center, Dallas.
  • Hieken TJ; Department of Surgery, Mayo Clinic, Rochester, Minnesota.
  • Carter JM; Laboratory Medicine and Pathology, May Clinic, Rochester, Minnesota.
  • Chen B; Laboratory Medicine and Pathology, May Clinic, Rochester, Minnesota.
  • Ahrendt G; Department of Surgery, University of Colorado Denver, Aurora.
  • Tchou J; Department of Surgery, University of Pennsylvania, Philadelphia.
  • Feldman M; Pathology & Laboratory Medicine, University of Pennsylvania, Philadelphia.
  • Tousimis E; Department of Surgery, Georgetown University, Washington, DC.
  • Zeck J; Pathology and Laboratory Medicine, Georgetown University, Washington, DC.
  • Jaskowiak N; Department of Surgery, University of Chicago, Illinois.
  • Sattar H; Department of Pathology, University of Chicago, Illinois.
  • Naik AM; Department of Surgery, Oregon Health & Science University, Portland.
  • Lee MC; Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida.
  • Rosa M; Department of Pathology, Moffitt Cancer Center, Tampa, Florida.
  • Khazai L; Department of Pathology, Moffitt Cancer Center, Tampa, Florida.
  • Rendi MH; Department of Pathology, University of Washington, Seattle.
  • Lang JE; Department of Surgery, University of Southern California, Los Angeles.
  • Lu J; Department of Medicine, University of Southern California, Los Angeles.
  • Tawfik O; Department of Pathology, University of Kansas, Kansas City.
  • Asare SM; Quantum Leap Healthcare Collaborative, San Francisco.
  • Esserman LJ; Department of Surgery, University of California San Francisco, San Francisco.
  • Mukhtar RA; Department of Surgery, University of California San Francisco, San Francisco.
JAMA Surg ; 157(11): 1034-1041, 2022 11 01.
Article en En | MEDLINE | ID: mdl-36069821
ABSTRACT
Importance Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer strongly correlates with overall survival and has become the standard end point in neoadjuvant trials. However, there is controversy regarding whether the definition of pCR should exclude or permit the presence of residual ductal carcinoma in situ (DCIS).

Objective:

To examine the association of residual DCIS in surgical specimens after neoadjuvant chemotherapy for breast cancer with survival end points to inform standards for the assessment of pathologic complete response. Design, Setting, and

Participants:

The study team analyzed the association of residual DCIS after NAC with 3-year event-free survival (EFS), distant recurrence-free survival (DRFS), and local-regional recurrence (LRR) in the I-SPY2 trial, an adaptive neoadjuvant platform trial for patients with breast cancer at high risk of recurrence. This is a retrospective analysis of clinical specimens and data from the ongoing I-SPY2 adaptive platform trial of novel therapeutics on a background of standard of care for early breast cancer. I-SPY2 participants are adult women diagnosed with stage II/III breast cancer at high risk of recurrence.

Interventions:

Participants were randomized to receive taxane and anthracycline-based neoadjuvant therapy with or without 1 of 10 investigational agents, followed by definitive surgery. Main Outcomes and

Measures:

The presence of DCIS and EFS, DRFS, and LRR.

Results:

The study team identified 933 I-SPY2 participants (aged 24 to 77 years) with complete pathology and follow-up data. Median follow-up time was 3.9 years; 337 participants (36%) had no residual invasive disease (residual cancer burden 0, or pCR). Of the 337 participants with pCR, 70 (21%) had residual DCIS, which varied significantly by tumor-receptor subtype; residual DCIS was present in 8.5% of triple negative tumors, 15.6% of hormone-receptor positive tumors, and 36.6% of ERBB2-positive tumors. Among those participants with pCR, there was no significant difference in EFS, DRFS, or LRR based on presence or absence of residual DCIS. Conclusions and Relevance The analysis supports the definition of pCR as the absence of invasive disease after NAC regardless of the presence or absence of DCIS. Trial Registration ClinicalTrials.gov Identifier NCT01042379.
Asunto(s)

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Neoplasias de la Mama / Carcinoma Ductal de Mama / Carcinoma Intraductal no Infiltrante Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Middle aged Idioma: En Año: 2022 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Neoplasias de la Mama / Carcinoma Ductal de Mama / Carcinoma Intraductal no Infiltrante Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Middle aged Idioma: En Año: 2022 Tipo del documento: Article