Author(s): Tks T, Szentmrtoni G, Torgyk L, Kajry K, Lengyel Z,
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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=\%, 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.
This article was published in Croat Med J
and referenced in Journal of Cancer Science & Therapy