Course of clinical response during primary systemic therapy with a dose-dense 4 cycles regime of adriamycin and docetaxel in patients with operable cancer of the breast

Background: <br>In contrast to adjuvant chemotherapy (AST), primary systemic therapy (PST) allows the observation of clinical response under treatment, serving as an in-vivo chemosensitivity test. One possibility to assess tumor response is the consideration and analysis of clinical parameters such as palpation of the tumor size. <br>Up to now, little is known about typical courses of tumor shrinkage or growth under PST. <br>The results of this dissertation support decision making in case of insufficient clinical response after a specific number of cycles of PST. <br>Methods: <br>Data on tumor palpation during PST based on n=436 patients with operable breast cancer (T2-3, N0-2, M0) in the dose-dense doxorubicin plus docetaxel (ADoc) therapy arm of the Geparduo trial (2005), a prospective randomized controlled phase III trial, has been investigated. <br>Primary aim was to assess the predictive value of clinical response for the primary endpoint, pathologic complete response (pCR). Secondary aim was to analyze the individual courses of clinical response by palpation in detail. <br>Results: <br>Half of the patients with a clinical complete response (cCR) after the last cycle of PST (31.19%) achieved the cCR only during the last cycle of PST. The negative predictive value (NPV) of a cCR in breast for a pCR in breast and axillary lymph nodes was constantly high throughout the course of PST. The positive predictive value (PPV) at any time-point during PST for a pCR in breast and axillary lymph nodes was low. The comparatively highest PPV was reached after the 3rd cycle of PST (23.8%). It cannot be deduced from a cCR early during PST that there is no chance of the tumor size increasing again during the further course of PST. The majority of patients (68.12%) experienced a monotonous decrease in tumor size during PST. <br>Conclusions: <br>In case the clinical response by palpation is used as a guide for further treatment, the hypothesis can be generated that it is advisable to decide not until after the 3rd cycle of PST whether a patient is categorized as a responder or non-responder to PST.

Author dc:creator

• Müller, Christine-Susanne

Contributors dc:contributor

• Schumacher, Martin

• Mammakarzinom
• primär systemische Therapie
• neoadjuvante Therapie
• klinische Response
• Palpation
• breast cancer
• chemotherapy
• primary systemic therapy
• neoadjuvant therapy
• clinical response

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https://freidok.uni-freiburg.de/data/2134

OAI identifier oai:identifier

oai:freidok.uni-freiburg.de:2134