Neoadjuvant chemotherapy for breast cancer: Pathologic response rates but not tumor size, has an independent prognostic impact on survival.

AIM: We investigated the pathologic complete response rates (pCR) and survival outcomes of early breast cancer patients who underwent neoadjuvant chemotherapy (NAC) over 14 years at a French comprehensive cancer center and reported pCR and survival outcomes by tumor subtypes and size. METHODS: From January 2005 to December 2018, 1150 patients receiving NAC were identified. Correlations between cT stage, breast tumor response, axillary lymph node response, pCR, surgery, and outcomes were assessed. pCR was defined as (ypT0/ypTis) and (ypN0/pN0sn). RESULTS: A pCR was reached in 31.7% (365/1150) of patients and was strongly associated with tumor subtypes, but not with tumor size (pretreatment cT category). Luminal-B Her2-negative and triple-negative (TN) subtypes, cN1 status, older age, and no-pCR had an independent negative prognostic value. Overall survival (OS), relapse-free survival (RFS), and metastasis-free survival (MFS) were not significantly different for cT0-1 compared to cT2 stages. In Cox-model adjusted on in-breast pCR and pN status, ypN1 had a strong negative impact (OS, RFS, and MFS: HR = 3.153, 4.677, and 6.133, respectively), higher than no in-breast pCR (HR = 2.369, 2.252, and 2.323). A negative impact of no pCR on OS was observed for cN0 patients and TN tumors (HR = 4.972) or HER2-positive tumors (HR = 11.706), as well as in Luminal-B Her2-negative tumors on MFS (HR = 2.223) and for Luminal-A on RFS (HR = 4.465) and MFS (HR = 4.185). CONCLUSION: Achievement of pCR, but not tumor size (pretreatment cT category), has an independent prognostic impact on survival. These results suggest potential NAC benefits in patients with small tumors (<2 cm), even in absence of clinically suspicious lymph nodes. Residual lymph node disease after NAC is the most powerful adverse prognostic factor.

Initial experience with hyperthermic intraperitoneal chemotherapy.

BACKGROUND: Until 2004, we treated peritoneal carcinomatosis with cytoreductive surgery accompanied by perioperative systemic chemotherapy. From October 2004, we decided to initiate a hyperthermic intraperitoneal chemotherapy (HIPEC) program for this condition. OBJECTIVE: To determine the effect of HIPEC on postoperative outcomes at a single institution performing a high volume of cancer operations. METHOD: Sixty consecutive patients underwent cytoreductive surgery plus HIPEC (oxaliplatin; 460 mg/m2 in 2 L/m2) from October 1, 2004, through December 31, 2010. Usual perioperative factors were studied for 3 groups of patients who underwent HIPEC: 0 to 20 HIPEC procedures (period 1), 21 to 40 HIPEC procedures (period 2), and 41 to 60 HIPEC procedures (period 3). RESULTS: The mean peritoneal carcinomatosis index was 9.6, the mean duration of surgery was 410.7 minutes, and the mean blood loss was 450.2 mL/L. Mortality and morbidity were 0% and 33%, respectively. Grade III/IV morbidity (P = .02), transfusion (P < .01), and reintervention rate (P = .04) significantly decreased during the 3 periods. No difference was seen between the 3 periods with regard to mean peritoneal carcinomatosis index, operative duration, blood loss, mortality, overall morbidity, length of hospital stay, and readmission. The overall 1-, 3-, and 5-year survival rates of 26 patients with peritoneal carcinomatosis originating from colorectal cancer were 100%, 51%, and 37%, respectively. The overall median survival was 39 months. CONCLUSIONS: We observed a significant reduction of grade III/IV morbidity, perioperative transfusion, and reintervention rate after 20 procedures. The introduction of the HIPEC program was successful because of the surgical team's prior experience in cytoreductive and cancer operations.

Clinical experience with the delivery of thawed and washed autologous blood cells, with an automated closed fluid management device: CytoMate.

BACKGROUND: Washing out of thawed autologous grafts, before reinfusion in poor-prognosis cancer patients who undergo high-dose chemotherapy, is desirable. The procedure allows for the reduction of infused dimethyl sulfoxide (DMSO) quantities and the performance of biologic controls on the infused cell product. STUDY DESIGN AND METHODS: Three-hundred four patients were treated with intensified chemotherapy and autologous transplantation at a single institution. Fifty-four of them received washed cell products, because three or more bags were to be reinfused. The recently available, closed, automated, and current good manufacturing practice-compliant device (CytoMate, Baxter Oncology) was used for this purpose. RESULTS: The performances of the device were similar to previously reported results, with greater than 75 percent CD34+ cell recovery. Neutrophil and platelet (PLT) recoveries were similar in the group of patients receiving washed cells and in the group of patients for whom cell products were extemporaneously thawed at the bedside. Adverse events that are typically reported after DMSO infusion were significantly less frequent and less severe in patients who received washed cells. Finally, the nurse staff on the transplant ward reported a decreased workload and more satisfactory procedure when infusing washed cell products. CONCLUSION: The CytoMate device allows for a significant reduction in DMSO infusion, with a diminished frequency and severity of immediate side effects and does not compromise neutrophil or PLT engraftment.