Multitudes are affected by breast cancer, the most prevalent type of cancer in Brazil and globally. As we step into a new year, Brazil anticipates a significant increase in new breast cancer cases, with many patients diagnosed in advanced stages. This paints a picture of the vital role of neoadjuvant chemotherapy (NAC), a therapy designed to shrink tumors prior to surgical removal. The success of NAC, especially in achieving a state of pathological complete response (pCR) – where no cancer traces remain after treatment – is a pivotal focus. Studies indicate that reaching pCR is linked to better survival rates, regardless of the cancer subtype. Yet, the true effectiveness of these treatments in everyday, diverse populations, particularly those often not included in clinical trials, remains a critical area of study. This research dives into this area, leveraging real-world data to assess treatment patterns and outcomes in a broader group of patients, inclusive of those typically excluded from clinical trials.
The research, orchestrated by Professor Marcelo Antonini and Dr. Gabriel Duque Pannain from Hospital do Servidor Público Estadual Francisco Morato de Oliveira; Dr. André Mattar, Dr. Marina Diogenes Teixeira, Dr. Andressa Gonçalves Amorim, and Dr. Luiz Henrique Gebrim from Women’s Health Hospital; Dr. Fernanda Grace Bauk Richter from Hospital do Ipiranga; and Professor Juliana Monte Real and Dr. Reginaldo Coelho Guedes Lopes, also from Hospital do Servidor Público Estadual Francisco Morato de Oliveira, is noted for its thorough and methodical approach. The team carefully collected and scrutinized data from female patients with non-spreading breast cancer who underwent NAC. This detailed analysis, featured in The Breast journal, involved a retrospective look at patient records, focusing on treatment results and survival probabilities.
Delving into their methods, Professor Antonini explained, “Our study included a large group of patients diagnosed with non-spreading breast cancer and treated with NAC. We meticulously tracked the rates of complete cancer disappearance after NAC and scrutinized their impact on overall health continuance and disease-free existence.” This approach allowed for a comprehensive understanding of treatment effectiveness across a varied patient group.
The core objective of the study was to evaluate the rate of pCR and its influence on overall and disease-free survival. The researchers found that a significant portion of patients achieved pCR, a noteworthy observation considering the diverse nature of breast cancer. This variation was particularly notable in patients with HER-2 positive tumors who received trastuzumab, a specific targeted therapy.
“The rates of complete cancer disappearance and their prognostic value varied across breast cancer types. In our study, achieving complete cancer disappearance could be seen as a sign of favorable clinical outcomes as it was linked with higher rates of continued health and disease-free existence,” remarked Professor Antonini. This observation is essential for understanding the differential impact of NAC.
In terms of survival analysis, the study revealed that patients who attained pCR had a considerably higher chance of continued health and disease-free existence over a five-year period, compared to those who did not reach pCR. A similar pattern was seen in disease-free existence rates, underlining the prognostic significance of pCR in treatment.
This research is especially significant for its setting in the real world, offering insights beyond the controlled environment of clinical trials. It emphasizes the role of pCR as a potential marker for predicting treatment outcomes in breast cancer patients undergoing NAC.
Concluding, Professor Antonini emphasized, “Patients who achieved complete cancer disappearance had a significantly higher chance of continued health and disease-free existence over a five-year period compared to the group that did not achieve this state.” This conclusive statement highlights the correlation between pCR and improved survival outcomes. The study by Marcelo Antonini and his team serves as a critical contribution to the field of oncology, particularly for healthcare professionals in Brazil and globally. It underscores the importance of personalized treatment strategies and the role of pCR as a surrogate marker for clinical outcomes in breast cancer treatment.
Marcelo Antonini, André Mattar, Fernanda Grace Bauk Richter, et al. “Real-world evidence of neoadjuvant chemotherapy for breast cancer treatment in a Brazilian multicenter cohort: Correlation of pathological complete response with overall survival,” The Breast, 2023. DOI: https://doi.org/10.1016/j.breast.2023.103577.
ABOUT THE AUTHOR
Dr. Marcelo Antonini is Preceptor of the Breast Surgery Medical Residency Program at Hospitaldo Servidor Público Estadual in São Paulo/Brazil. PhD in Health Sciences. Professor at the Santo Amaro University (UNISA) and the University of the City of São Paulo (UNICID).