Early ultrasound evaluation identifies excellent responders to neoadjuvant systemic therapy among patients with triple‐negative breast cancer. Issue 16 (20th April 2021)

• Record Type: Journal Article
• Authors: Adrada, Beatriz E.; Candelaria, Rosalind; Moulder, Stacy; Thompson, Alastair; Wei, Peng; Whitman, Gary J.; Valero, Vicente; Litton, Jennifer K.; Santiago, Lumarie; Scoggins, Marion E.; Moseley, Tanya W.; White, Jason B.; Ravenberg, Elizabeth E.; Yang, Wei T.; Rauch, Gaiane M.
• Is Part Of: Cancer. Volume 127:Issue 16(2021)
• Page Start: 2880
• Page End: 2887
• Publication Date: 2021-04-20
• Subjects: breast cancer -- imaging -- neoadjuvant systemic therapy (NAST) -- triple‐negative breast cancer (TNBC) -- ultrasound; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.33604
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: Heterogeneity exists in the response of triple‐negative breast cancer (TNBC) to standard anthracycline (AC)/taxane‐based neoadjuvant systemic therapy (NAST), with 40% to 50% of patients having a pathologic complete response (pCR) to therapy. Early assessment of the imaging response during NAST may identify a subset of TNBCs that are likely to have a pCR upon completion of treatment. The authors aimed to evaluate the performance of early ultrasound (US) after 2 cycles of neoadjuvant NAST in identifying excellent responders to NAST among patients with TNBC. METHODS: Two hundred fifteen patients with TNBC were enrolled in the ongoing ARTEMIS (A Robust TNBC Evaluation Framework to Improve Survival) clinical trial. The patients were divided into a discovery cohort (n = 107) and a validation cohort (n = 108). A receiver operating characteristic analysis with 95% confidence intervals (CIs) and a multivariate logistic regression analysis were performed to model the probability of a pCR on the basis of the tumor volume reduction (TVR) percentage by US from the baseline to after 2 cycles of AC. RESULTS: Overall, 39.3% of the patients (42 of 107) achieved a pCR. A positive predictive value (PPV) analysis identified a cutoff point of 80% TVR after 2 cycles; the pCR rate was 77% (17 of 22) in patients with a TVR ≥ 80%, and the area under the curve (AUC) was 0.84 (95% CI, 0.77‐0.92; P < .0001). In the validation cohort, the pCR rate was 44%. The PPV for pCR with a TVR ≥ 80% after 2 cycles was 76% (95% CI, 55%‐91%), and the AUC was 0.79 (95% CI, 0.70‐0.87; P < .0001). CONCLUSIONS: The TVR percentage by US evaluation after 2 cycles of NAST may be a cost‐effective early imaging biomarker for a pCR to AC/taxane‐based NAST. Abstract : Early ultrasound imaging identifies excellent responders to neoadjuvant systemic therapy among patients with triple‐negative breast cancer. The percentage of tumor volume reduction by ultrasound may be a cost‐effective imaging biomarker for predicting a pathologic complete response.