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- Title
Early ultrasound evaluation identifies excellent responders to neoadjuvant systemic therapy among patients with triple-negative breast cancer.
- 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.
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Subjects
TRIPLE-negative breast cancer; ULTRASONIC imaging; RECEIVER operating characteristic curves; LOGISTIC regression analysis; BREAST cancer
- Publication
Cancer (0008543X), 2021, Vol 127, Issue 16, p2880
- ISSN
0008-543X
- Publication type
journal article
- DOI
10.1002/cncr.33604