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Pathological response to neoadjuvant chemoradiation related to improved DFS, OS

Adams S. Breast Cancer Res Treat. 2010;doi:10.1007/s10549-010-1181-8.

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Patients with locally advanced breast cancer who showed a pathologic response to concurrent paclitaxel and radiation therapy experienced superior DFS and OS, according to researchers from New York University.

The researchers studied the pathological response rates of neoadjuvant radiation and chemotherapy in patients with locally advanced breast cancer. The response rates were previously reported. In this paper, they reported the DFS and OS.

“Pathological response to systemic therapies has demonstrated to be an invaluable intermediate endpoint, since it is a surrogate of DFS and OS after neoadjuvant therapy,” the researchers wrote. “However … pathological response rates following standard multi-agent chemotherapy remain relatively low. Preoperative radiotherapy after neoadjuvant anthracycline-based chemotherapy failed to enhance the pathological response rate. … Studies of concurrent regimens are uncommon in breast cancer.”

The study included 105 patients who were treated with concurrent neoadjuvant paclitaxel and radiation between March 1997 and August 2009. Pathological response after neoadjuvant treatment was reached in 34% of the patients. The pathological response rate was higher in patients with hormone receptor-negative tumors.

A pathological response was significantly associated with better DFS and OS. At a median follow-up of 60 months, the median DFS and OS have not been reached. For non-responders, the median DFS was 57 months and the median OS was 84 months. The DFS and the OS for pathological responders have not yet been reached. Six patients with a pathological response recurred, whereas 23 non-responders recurred.

Despite adverse characteristics in the patient population, the data “suggest that preoperatively administered concurrent paclitaxel/radiation achieves comparable results to those of modern neoadjuvant chemotherapy with respect to pathologic response rate and OS,” the researchers wrote.

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