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Preoperative concurrent paclitaxel-radiation in locally advanced breast cancer: pathologic response correlates with five-year overall survival

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Abstract

We have previously demonstrated high pathologic response rates after neoadjuvant concurrent chemoradiation in patients with locally advanced breast cancer (LABC). We now report disease-free survival (DFS) and overall survival (OS) in the context of pathologic response. 105 LABC patients (White 46%, Non-White 54%) were treated with paclitaxel (30 mg/m2 intravenously twice a week) for 10–12 weeks. Daily radiotherapy was delivered to breast, axillary, and supraclavicular lymph nodes during weeks 2–7 of paclitaxel treatment, at 1.8 Gy per fraction to a total dose of 45 Gy with a tumor boost of 14 Gy at 2 Gy/fraction. Pathological complete response (pCR) was defined as the absence of invasive cancer in breast and lymph nodes and pathological partial response (pPR) as the persistence of <10 microscopic foci of invasive carcinoma in breast or lymph nodes. Pathologic response (pCR and pPR) after neoadjuvant chemoradiation was achieved in 36/105 patients (34%) and was associated with significantly better DFS and OS. Pathological responders had a lower risk of recurrence or death (HR = 0.35, P = 0.01) and a longer OS (HR = 4.27, P = 0.01) compared with non-responders. Median DFS and OS were 57 and 84 months for non-responders, respectively, and have not yet been reached for responders. Importantly, pathologic response was achieved in 54% of patients with HR negative tumors (26/48). In conclusion, pathologic response to concurrent paclitaxel-radiation translated into superior DFS and OS. Half of the patients with HR negative tumors achieved a pathologic response.

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Acknowledgments

We thank all the participating patients, treating physicians, and research teams at NYU, USC, and Vanderbilt University. The study was supported by the: Department of Defense Breast Cancer Research Program Center of Excellence (W81XWH-04-1-0905, to S.C.F., J.D.G., T.H. and R.J.S.), American Cancer Society (TURSG CCE 103174, to S.C.F.), National Institutes of Health Grants 5P30 CA016037-30 (NYU Core Services), K23CA125205P50 (to S.A.), CA95131 (Specialized Program of Research Excellence in Breast Cancer, to J.A.P.); CA105436 and CA070856 (to J.A.P.); ES00267 and CA68485 (Vanderbilt Core Services); CA009385 and CA138106 (to J.A.B.); US Army grant DAMD17-99-1-9422 (to J.A.P.); California Breast Cancer Research Program BCRP TRC 4E-6000 (to S.C.F.), Breast Cancer Research Foundation (to S.C.F. and R.J.S.), Avon Foundation 15D1500-36300 (to S.C.F. and R.J.S.), New York University General Clinical Research Center (NIH/NCRR M01 RR000096), and a Vanderbilt-Ingram Cancer Center Discovery Grant (to A.B.C.).

Conflicts of interest

A.B.C received research funding from Bristol-Meyers Squibb.

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Authors and Affiliations

  1. Department of Radiation Oncology, New York University School of Medicine, 160 E 34th Street, New York, NY, 10016, USA

    Sylvia Adams, Martin Donach, Stella Lymberis, Baljit Singh, Tsivia Hochman, Judith D. Goldberg, Franco Muggia, Robert J. Schneider & Silvia C. Formenti

  2. Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA

    A. Bapsi Chakravarthy, Joshua A. Bauer & Jennifer A. Pietenpol

  3. Kenneth Norris Jr. Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    Darcy Spicer

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  1. Sylvia Adams
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Correspondence to Silvia C. Formenti.

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Adams, S., Chakravarthy, A.B., Donach, M. et al. Preoperative concurrent paclitaxel-radiation in locally advanced breast cancer: pathologic response correlates with five-year overall survival. Breast Cancer Res Treat 124, 723–732 (2010). https://doi.org/10.1007/s10549-010-1181-8

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  • DOI: https://doi.org/10.1007/s10549-010-1181-8

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