Pathological complete response and long-term clinical benefit in breast cancer: The CTNeoBC pooled analysis

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  • Cortazar, Patricia
    • Other Affiliation: US Food and Drug Administration, Silver Spring, MD, USA
  • Zhang, Lijun
    • Other Affiliation: US Food and Drug Administration, Silver Spring, MD, USA
  • Untch, Michael
    • Other Affiliation: HELIOS Klinikum, Berlin, Germany
  • Mehta, Keyur
    • Other Affiliation: German Breast Group, Neu-Isenburg, Germany
  • Constantino, Joseph P.
    • Other Affiliation: National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA
  • Wolmark, Norman
    • Other Affiliation: National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA
  • Bennefoi, Herve
    • Other Affiliation: Institut Bergonié INSERM U916 and Université Bordeaux Segalen, Bordeaux, France
  • Cameron, David
    • Other Affiliation: Edinburgh Cancer Research Centre, University of Edinburgh and NHS Lothian, UK
  • Gianni, Luca
    • Other Affiliation: San Raffaele Scientific Institute, Milan, Italy
  • Valagussa, Pinuccia
    • Other Affiliation: Fondazione Michelangelo, Milan, Italy
  • Swain, Sandra M.
    • Other Affiliation: Medstar Washington Hospital Center, Washington, DC, USA
  • Prowell, Tatiana
    • Other Affiliation: US Food and Drug Administration, Silver Spring, MD, USA
  • Loibl, Sibylle
    • Other Affiliation: German Breast Group, Neu-Isenburg, Germany
  • Wickerham, Lawrence
    • Other Affiliation: National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA
  • Bogaerts, Jan
    • Other Affiliation: EORTC Headquarters, Brussels, Belgium
  • Baselga, Joseph P.
    • Other Affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY, USA
  • Perou, Charles
  • Blumenthal, Gideon
    • Other Affiliation: US Food and Drug Administration, Silver Spring, MD, USA
  • Blohmer, Jens
    • Other Affiliation: St Gertrauden Hospital, Berlin, Germany
  • Mamounas, Eleftherios P.
    • Other Affiliation: MD Anderson Cancer Center Orlando, Orlando, FL, USA
  • Bergh, Jonas
    • Other Affiliation: KarolinskaInstitutet and University Hospital, Stockholm, Sweden
  • Semiglazov, Vladimir
    • Other Affiliation: NN Petrov Research Institute of Oncology, St Petersburg, Russia
  • Justice, Robert
    • Other Affiliation: US Food and Drug Administration, Silver Spring, MD, USA
  • Eidtmann, Holger
    • Other Affiliation: University Women's Hospital, Kiel, Germany
  • Paik, Soonmyung
    • Other Affiliation: National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA
  • Piccart, Martine
    • Other Affiliation: Jules Bordet Institute, Brussels, Belgium
  • Sridhara, Rajeshwari
    • Other Affiliation: US Food and Drug Administration, Silver Spring, MD, USA
  • Fasching, Peter A.
    • Other Affiliation: Frauenklinik des Universitätsklinikums, Erlangen, Germany
  • Slaets, Leen
    • Other Affiliation: EORTC Headquarters, Brussels, Belgium
  • Tang, Shenghui
    • Other Affiliation: US Food and Drug Administration, Silver Spring, MD, USA
  • Gerber, Bernd
    • Other Affiliation: Universitäts Frauenklinik, Rostock, Germany
  • Geyer, Charles E., Jr.
    • Other Affiliation: Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
  • Pazdur, Richard
    • Other Affiliation: US Food and Drug Administration, Silver Spring, MD, USA
  • Ditsch, Nina
    • Other Affiliation: Hospital of the Ludwig Maximilian University of Munich, Munich, Germany
  • Rastogi, Priya
    • Other Affiliation: National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA
  • Eiermann, Wolfgang
    • Other Affiliation: Hospital of the Ludwig Maximilian University of Munich, Munich, Germany
  • von Minckwitz, Gunter
    • Other Affiliation: German Breast Group, Neu-Isenburg, Germany
Abstract
  • "Background Pathological complete response has been proposed as a surrogate endpoint for prediction of long-term clinical benefit, such as disease-free survival, event-free survival (EFS), and overall survival (OS). We had four key objectives: to establish the association between pathological complete response and EFS and OS, to establish the definition of pathological complete response that correlates best with long-term outcome, to identify the breast cancer subtypes in which pathological complete response is best correlated with long-term outcome, and to assess whether an increase in frequency of pathological complete response between treatment groups predicts improved EFS and OS. Methods We searched PubMed, Embase, and Medline for clinical trials of neoadjuvant treatment of breast cancer. To be eligible, studies had to meet three inclusion criteria: include at least 200 patients with primary breast cancer treated with preoperative chemotherapy followed by surgery; have available data for pathological complete response, EFS, and OS; and have a median follow-up of at least 3 years. We compared the three most commonly used definitions of pathological complete response—ypT0 ypN0, ypT0/is ypN0, and ypT0/is—for their association with EFS and OS in a responder analysis. We assessed the association between pathological complete response and EFS and OS in various subgroups. Finally, we did a trial-level analysis to assess whether pathological complete response could be used as a surrogate endpoint for EFS or OS. Findings We obtained data from 12 identified international trials and 11 955 patients were included in our responder analysis. Eradication of tumour from both breast and lymph nodes (ypT0 ypN0 or ypT0/is ypN0) was better associated with improved EFS (ypT0 ypN0: hazard ratio [HR] 0·44, 95% CI 0·39–0·51; ypT0/is ypN0: 0·48, 0·43–0·54) and OS (0·36, 0·30–0·44; 0·36, 0·31–0·42) than was tumour eradication from the breast alone (ypT0/is; EFS: HR 0·60, 95% CI 0·55–0·66; OS 0·51, 0·45–0·58). We used the ypT0/is ypN0 definition for all subsequent analyses. The association between pathological complete response and long-term outcomes was strongest in patients with triple-negative breast cancer (EFS: HR 0·24, 95% CI 0·18–0·33; OS: 0·16, 0·11–0·25) and in those with HER2-positive, hormone-receptor-negative tumours who received trastuzumab (EFS: 0·15, 0·09–0·27; OS: 0·08, 0·03, 0·22). In the trial-level analysis, we recorded little association between increases in frequency of pathological complete response and EFS (R2=0·03, 95% CI 0·00–0·25) and OS (R2=0·24, 0·00–0·70). Interpretation Patients who attain pathological complete response defined as ypT0 ypN0 or ypT0/is ypN0 have improved survival. The prognostic value is greatest in aggressive tumour subtypes. Our pooled analysis could not validate pathological complete response as a surrogate endpoint for improved EFS and OS. Funding US Food and Drug Administration."
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  • Article
Rights statement
  • In Copyright
Journal title
  • The Lancet
Journal volume
  • 384
Journal issue
  • 9938
Page start
  • 164
Page end
  • 172
Language
  • English
Version
  • Postprint
ISSN
  • 0140-6736

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