Rigter, L. (Lisanne) (2012) Neoadjuvant chemotherapy adaptation and serial MRI response monitoring in ER-positive HER2-negative breast cancer. thesis, Medicine.
Full text available on request.Abstract
Introduction: Changing the neoadjuvant chemotherapy regimen in insufficiently responding breast cancer is not a standard policy. We analysed a consecutive series of patients in whom the second three courses of neoadjuvant chemotherapy were selected based on the response to the first three courses. Materials and methods: Estrogen receptor positive, human epidermal growth factor 2 receptor negative breast cancer patients received three courses of neoadjuvant dose dense Doxorubicin/Cyclophosphamide (ddAC). Serial contrast enhanced Magnetic Resonance Imaging (CE-MRI) studies before chemotherapy, after three and after six courses of chemotherapy were obtained. Three further courses of ddAC were administered in case of a favorable response on the second MRI and a switch to Docetaxel and Capecitabine was made in case of an unfavorable response. The efficacy of this approach was evaluated by pathological response, relapse free interval and by tumor size reductions on serial CE-MRI. Results: 309 patients were included. Early response was evaluated by MRI in 275 patients and in 180 patients all three serial MRI measurements were obtained. Pathological response was better in patients who had a favorable initial MRI response (p=0.067 for Neoadjuvant Response Index, p=0.022 for a pathological complete remission of the breast). The MRI response had no impact on the relapse free interval (p=0.296). Unfavorable initial responders had a median tumor size reduction of 8% after 3 courses of ddAC, while favorable responders had a 34% reduction. After switching to the alternative chemotherapy regimen, their tumor size reduction was 36% after three additional courses, while that of initially favorable responders who continued their successful first chemotherapy was 45%. A tumor diameter on MRI smaller than the median after six courses of neoadjuvant chemotherapy was a favorable prognostic factor for the recurrence free interval (hazard ratio 3.0 (95% confidence interval 1.0 – 9.3), p=0.045). Conclusions: The tumor size reduction of initially non-responsive tumors after treatment adaptation adds further evidence that a response-adapted strategy may enhance the efficacy of neoadjuvant chemotherapy. Prospective studies to optimally exploit this treatment strategy are warranted.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Imholz, Dr. |
| Supervisor name: | Extern begeleider: and Rodenhuis, Prof. dr. and Antoni van Leeuwenhoek Ziekenhuis and Interne geneeskunde |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:44 |
| Last Modified: | 25 Jun 2020 10:44 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/550 |
Actions (login required)
 |
View Item |