Dados do Trabalho

Título

RESPOSTA PATOLOGICA COMPLETA EM 2.141 PACIENTES SUBMETIDOS A QUIMIOTERAPIA NEOADJUVANTE EM UM CENTRO DE REFERENCIA PARA CANCER DE MAMA

Título em Inglês

PATHOLOGICAL COMPLETE RESPONSE in 2,141 PATIENTS SUBMITTED TO NEOADJUVANT CHEMOTHERAPY IN A BREAST CANCER REFERENCE CENTER

Introdução

The pathological complete response (pCR) definition after neoadjuvant chemotherapy (NAC) for breast cancer is better defined as the absence of residual invasive cancer, although it allows the presence of ductal carcinoma in situ (DCIS) (1-3). In the past, the presence of positive axillary lymph node was permitted, nowadays studies have shown that any positive lymph node should be not considered as pCR (3). In Brazil, the proportion of advanced cases varies between 30 to 55% of patients treated by the public health system (SUS). NAC has been recommended more frequently, especially triple negative tumors and overexpressed Her 2 tumors because you can possibly change the adjuvant treatment and It is an excellent predictor of prognosis (4, 5). There is little data on pCR in the therapeutic regimens used in SUS.

Objetivos

Evaluate data on pathological complete responde in patients subjected to neoadjuvant chemotherapy in SUS schemes.

Métodos

We performed a retrospective study in the Perola Byington Hospital official database from January 2011 to December 2018 and 2,141 patients that underwent neoadjuvant chemotherapy (NAC) were included. Chemotherapy regimens varied during the period according to institutional protocols and availability of new drugs. The pCR was considered after a histopathological study of the surgical specimen in the 4 molecular subtypes (luminal A and B, triple negative and HER -2 enriched).

Resultados

We included 494 patients in Stage IIB and 1,645 patients in Stage III, most of them were luminal (1077/50,3%), followed by triple negative (766/35,8%) and Her2 (298/13,9%). The pCR rate varied across the subtypes: luminal 78 (7,2%), triple negative 163 (21,3%) and Her2 69(23,1%).

Conclusões

NAC is an important treatment for breast cancer and is gaining gradually more indications. Most of the indications for NAC are: To allow surgical approaches (advanced cases); To allow / increase rate of conservative surgery; To allow conservative approach to the axila and recently select some cases for specific treatment (adjuvant TDM1 and capecitabine)(6, 7). The pCR rate vary through the studies, Cortazar et al found 16% in Luminal; 33% in triple negative; 50% in Her2 when trastuzumab was used and 30,2% when it was not used (8). When platin is used for triple negative is possible to achieve up to 50% of pCR (9). When double blockage for her 2 is used we can expect between 50-70% in pCR (9). In our data most of our patients were stage 3 and we only had access to neoadjuvant trastuzumab after 2016, this directly impacted our results. The NAC protocols varied during this period and nowadays we’ve included platin compounds for triple negative.

Palavras Chave

The pathological complete response (pCR); neoadjuvant chemotherapy (NAC)

Área

TREATMENT - Treatment – other