Original scientific paper
https://doi.org/10.3325/cmj.2015.56.128
Response evaluation after primary systemic therapy of Her2 positive breast cancer – an observational crosssectional study
Tímea Tőkés
; Semmelweis University, 1st Dept. of Internal Medicine, Oncological Division, Budapest, Hungary
Gyöngyvér Szentmártoni
; Semmelweis University, 1st Dept. of Internal Medicine, Oncological Division, Budapest, Hungary
László Torgyík
; Semmelweis University, 1st Dept. of Internal Medicine, Oncological Division, Budapest, Hungary
Kornélia Kajáry
; Pozitron PET/CT Center, Budapest, Hungary
Zsolt Lengyel
; Pozitron PET/CT Center, Budapest, Hungary
Tamás Györke
; Semmelweis University Department of Nuclear Medicine Budapest, Hungary
Béla Á. Molnár
; Semmelweis University, 1st Department of Surgery, Budapest, Hungary
Anna-Mária Tőkés
; MTA-SE Tumor Progression Research Group, 2nd Department of Pathology, Budapest, Hungary
Janina Kulka
; Semmelweis University, 2nd Department of Pathology Budapest, Hungary
Magdolna Dank
; Semmelweis University, 1st Dept. of Internal Medicine, Oncological Division, Budapest, Hungary
Abstract
Aim To evaluate (I) trastuzumab-containing primary systemic
therapy (PST) in human epidermal growth factor receptor 2
(Her2) overexpressing breast carcinomas.; (II) compare the patients
who achieved and those who did not achieve pathological
complete remission (pCR), and (III) analyze the accuracy of
different clinical-imaging modalities in tumor response monitoring.
Methods 188 patients who received PST between 2008 and
2014 were reviewed and 43 Her2 overexpressing breast cancer
patients (28 Luminal B/Her2-positive and 15 Her2-positive)
were enrolled. 26 patients received mostly taxane-based PST
without trastuzumab (Group 1) and 17 patients received trastuzumab-
containing PST (Group 2). We compared the concordance
between pCR and complete remission (CR) defined
by breast-ultrasound, CR defined by standard 18F-fluoro-deoxy-
glucose positron emission tomography and computerized
tomography (FDG-PET/CT) criteria (Method 1) and CR
defined by a novel, breast cancer specific FDG-PET/CT criteria
(Method 2). Sensitivity (sens), specificity (spec), and positive
(PPV) and negative predictive values (NPV) were calculated.
Results Ten patients (38.5%) in Group 1 and eight (47%) in
Group 2 achieved pCR. pCR was significantly more frequent in
Her2-positive than in Luminal B/Her2-positive tumors in both
Group 1: (P = 0.043) and Group 2: (P = 0.029). PET/CT evaluated
by the breast cancer specific criteria (Method 2) differentiated
pCR from non-pCR more accurately in both groups (Group
1: sens = 77.8%, spec = 100%, PPV = 100%, NPV = 71.4%; Group
2: sens = 87.5%, spec = 62.5%, PPV = 70%, NPV = 83.3%) than
standard PET/CT criteria (Method 1) (Group 1: sens = 22.2%
spec = 100% PPV = 100% NPV = 41.7%; in Group 2: sens = 37.5%,
spec = 87.5%, PPV = 75% NPV = 58.3%) or breast ultrasound
(Group 1, sens = 83.3% spec = 25% PPV = 62.5% NPV = 50%;
Group 2, sens = 100% spec = 12.5% PPV = 41.6% NPV = 100%).
Conclusion The benefit of targeted treatment with trastuzumab-
containing PST in Her2 overexpressing breast cancer
was defined in terms of pCR rate. Luminal B/Her2-positive
subtype needs further subdivision to identify patients who
would benefit from PST. Combined evaluation of tumor response
by our novel, breast cancer specific FDG-PET/CT criteria
accurately differentiated pCR from non-pCR patients.
Keywords
Hrčak ID:
139304
URI
Publication date:
15.4.2015.
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