Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinicopathological predictors of long-term benefit in breast cancer treated with neoadjuvant chemotherapy
Marco Galvez, Carlos A Castaneda, Joselyn Sanchez, Miluska Castillo, Lia Pamela Rebaza, Gabriela Calderon, Miguel De La Cruz, Jose Manuel Cotrina, Julio Abugattas, Jorge Dunstan, Henry Guerra, Omar Mejia, Henry L Gomez
Marco Galvez, Carlos A Castaneda, Henry L Gomez, Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
Carlos A Castaneda, Faculty of Medicine, Universidad Peruana San Juan Bautista, Lima 15067, Peru
Joselyn Sanchez, Miluska Castillo, Lia Pamela Rebaza, Omar Mejia, Department of Research, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
Gabriela Calderon, Miguel De La Cruz, Jose Manuel Cotrina, Julio Abugattas, Jorge Dunstan, Department of Breast Cancer Surgery, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
Henry Guerra, Department of Pathology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
Author contributions: Galvez M, Castaneda CA and Rebaza LP contributed to the conception and design of the study , performed data analysis and interpretation; Galvez M, Castaneda CA, Sanchez J, Castillo M, Rebaza LP and Mejia O performed data acquisition, as well as provided administrative, technical and material support; all authors drafted the article and made critical revisions related to the intellectual content of the manuscript, and approved the final version of the article to be published.
Institutional review board statement: This study was reviewed and approved by the Instituto Nacional de Enfermedades Neoplasicas Institutional Review Board. Personal and filiation data including identity of every patient was protected with an added code in the Excel table. This is a retrospective case series that did not have any activity or contact with the patients.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All of the authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Carlos A Castaneda, MD, MSc, Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520 Surquillo, Lima 15038, Peru. ccastaneda@inen.sld.pe
Telephone: +51-1-6204991
Received: June 28, 2017
Peer-review started: July 3, 2017
First decision: December 7, 2017
Revised: December 19, 2017
Accepted: February 5, 2018
Article in press: February 5, 2018
Published online: April 10, 2018
ARTICLE HIGHLIGHTS
Research background
Breast cancer can be classified into Luminal A, Luminal B, HER2-enriched and triple-negative. Clinicopathological features can identify breast cancer prognosis and include pathological complete response (tumor sensibility to chemotherapy) and tumor-infiltrating lymphocytes (TILs; host activity against the tumor).
Research motivation
Discussion and new information about molecular breast cancer subtypes have been included in the most relevant cancer-related meeting, and more than 30,000 articles have been published in the last 2 years. Two biomarkers, pathological complete response (pCR) and TILs, have been re-defined and gained pathologist acceptance in the last 3 years.
Research objectives
The main objective is to evaluate the survival impact of different clinicopathological factors, including pCR and TIL levels, according to the subtypes in breast cancer patients who received neoadjuvant chemotherapy.
Research methods
Evaluation of TIL levels was prospectively performed following international guidelines. Breast cancer cases were classified according to 2017 St Gallen Breast Cancer Meeting guidelines.
Research results
pCR was associated with cT1-2 (P = 0.045) and high stromal (s)TILs (P = 0.029) in the entire population. However, this relationship was not found for every molecular subtype, probably because of the small sample size. pCR was associated with longer disease-free survival in the entire population (P = 0.002) and in TNBC (P < 0.001), as well as to longer overall survival in the entire population (P = 0.002) and in TNBC (P = 0.005).
Research conclusions
Predictive and prognostic value of clinicopathological features like pCR and sTIL level differ depending on the molecular subtype being evaluated. Identification of pCR and TIL roles in every molecular subtype will allow for identification of those patients who need more intense chemotherapy and those who will benefit from an immune-modulator treatment.
Research perspectives
No information about the relevance of pCR and TILs in South-American women with breast cancer have been published in. An increase in the knowledge about prognosis impact of pCR and TIL in every molecular breast cancer subtype will allow for obtaining more effective personalized therapies. Furthermore, similar analysis needs to be done with more precise methods to evaluate response to chemotherapy and host immune activity, such as tumor residual burden and CD3/CD8 ratio, respectively.
