Influences on pathologic complete response in breast cancer patients after neoadjuvant chemotherapy

Purpose Pathologic complete response is associated with longer disease-free survival and better overall survival after neoadjuvant chemotherapy in breast cancer patients. We, therefore, evaluated factors influencing pathologic complete response. Methods Patients receiving neoadjuvant chemotherapy from 2015 to 2018 at the Saarland University Hospital were included. Patients’ age, tumor stage, tumor biology, genetic mutation, recurrent cancer, discontinuation of chemotherapy, and participation in clinical trials were extracted from electronic medical records. Binary logistic regression was performed to evaluate the influence of these factors on pathologic complete response. Results Data of 183 patients were included. The median patient’s age was 54 years (22–78). The median interval between diagnosis and onset of chemotherapy was 28 days (14–91); between end of chemotherapy and surgery 28 days (9–57). Sixty-two patients (34%) participated in clinical trials for chemotherapy. A total of 86 patients (47%) achieved pathologic complete response. Patient’s age, genetic mutation, recurrent cancers, or discontinuation of chemotherapy (due to side effects) and time intervals (between diagnosis and onset of chemotherapy, as well as between end of chemotherapy and surgery) did not influence pathologic complete response. Patients with high Ki67, high grading, Her2 positive tumors, as well as patients participating in clinical trials for chemotherapy had a higher chance of having pathologic complete response. Patients with Luminal B tumors had a lower chance for pathologic complete response. Conclusion Particularly patients with high risk cancer and patients, participating in clinical trials benefit most from chemotherapy. Therefore, breast cancer patients can be encouraged to participate in clinical trials for chemotherapy

Factors influencing the time to surgery after neoadjuvant chemotherapy in breast cancer patients

Purpose It is suspected that delayed surgery after neoadjuvant chemotherapy (NACT) leads to a worse outcome in breast cancer patients. We therefore evaluated possible influencing factors of the time interval between the end of NACT and surgery. Methods All patients receiving NACT due to newly diagnosed breast cancer from 2015 to 2017 at the Department of Gynecology, Saarland University Medical Center, were included. The time interval between end of NACT and surgery was defined as primary endpoint. Possible delaying factors were investigated: age, study participation, outpatient and inpatient presentations, implants/expander, MRI preoperatively, discontinuation of chemotherapy, and genetic mutations. Results Data of 139 patients was analyzed. Median age was 53 years (22–78). The time interval between end of NACT and surgery was 28 days (9–57). Additional clinical presentations on outpatient basis added 2 days (p = 0.002) and on inpatient basis added 7 days to time to surgery (p < 0.001). Discontinuation of NACT due to chemotherapy side effects prolonged time to surgery by 8 days (p < 0.001), whereas discontinuation due to disease progress did not delay surgery (p = 0.6). In contrast, a proven genetic mutation shortened time to surgery by 7 days (p < 0.001). Patient’s age, participation in clinical studies, oncoplastic surgery, and preoperative MRI scans did not delay surgery. Conclusion Breast care centers should emphasize a reduction of clinical presentations and a good control of chemotherapy side effects for breast cancer patients to avoid delays of surgery after NACT