Journal of the National Cancer Institute Advance Access originally published online on April 29, 2008
JNCI Journal of the National Cancer Institute 2008 100(9):680; doi:10.1093/jnci/djn107
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© The Author 2008. Published by Oxford University Press.
CORRESPONDENCE |
Re: HER2 Status and Efficacy of Adjuvant Anthracyclines in Early Breast Cancer: A Pooled Analysis of Randomized Trials
Affiliation of authors: School of Medicine, University of California, Irvine, CA
Correspondence to: Rita S. Mehta, MD, Division of Hematology Oncology, Department of Internal Medicine, University of California, Irvine, 101 City Dr, Bldg 56, Rte 81, Orange, CA 92868-3201 (e-mail: rsmehta{at}uci.edu).
Gennari et al. (1) report an interaction between HER2 status and anthracycline chemosensitivity, but they do not mention tumor grade. Multivariable analysis has revealed that Scarff–Bloom–Richardson grade III tumors respond better to neoadjuvant treatment than Scarff–Bloom–Richardson grade I tumors (P < .0001) (2). A recent study suggests that an interaction between HER2 and estrogen receptor pathways may lead to higher proliferation rate and thus a higher tumor grade (3). Therefore, inclusion of tumor grade might have increased the relative predictive value of HER2 status and grade in predicting anthracycline chemosensitivity (2). Moreover, among patients who have HER2-negative, estrogen receptor–positive breast cancer, those with higher tumor grades may benefit from anthracycline (2). Furthermore, among patients who have HER2-negative, estrogen receptor–negative, and progesterone receptor–negative breast cancer, we have demonstrated a high rate of pathological complete response (4), which is an accepted surrogate of improved survival (5,6). Of the 15 patients who received four cycles of dose-dense anthracycline (doxorubicin) and cyclophosphamide followed by three cycles of paclitaxel (cremophor or albumin-bound paclitaxel) plus or minus carboplatin (both at 3 weeks on, 1 week off for one cycle) plus or minus six doses of bevacizumab every 2 weeks, 9 (60%; 95% confidence interval = 32% to 84%) achieved pathological complete response (4). Specifically, with anthracyclines given biweekly compared with every 3 weeks, there is a higher pathological complete response and, as a result, improved survival (7). Therefore, the pooled analysis needs to be replicated or refuted in the biweekly anthracycline setting, specifically in estrogen receptor–negative breast cancer.
REFERENCES
1. Gennari A, Sormani MP, Pronzato P, et al. HER2 status and efficacy of adjuvant anthracyclines in early breast cancer: a pooled analysis of randomized trials. J Natl Cancer Inst (2008) 100(1):14–20.
2. Amat S, Penault-Llorca F, Cure H, et al. Scarff-Bloom-Richardson (SBR) grading: a pleiotropic marker of chemosensitivity in invasive ductal breast carcinomas treated by neoadjuvant chemotherapy. Int J Oncol (2002) 20(4):791–796.[Web of Science][Medline]
3. Bartlett JMS, Ellis IO, Dowsett M, et al. Human epidermal growth factor receptor 2 status correlates with lymph node involvement in patients with estrogen receptor (ER) negative, but with grade in those with ER-positive early-stage breast cancer suitable for cytotoxic chemotherapy. J Clin Oncol (2007) 25(28):4423–4430.
4. Chen JH, Mehta RS, Carpenter PM, Nalcioglu O, Su M-Y. MRI in predicting pathological response of triple negative breast cancer following neoadjuvant chemotherapy. J Clin Oncol (2007) 25(35):5667.
5. Bear HD, Anderson S, Smith RE, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol (2006) 24(13):2019–2027.
6. Symmans WF, Peintinger F, Hatzis C, et al. Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy. J Clin Oncol (2007) 25(28):4414–4422.
7. Berry DA, Cirrincione C, Henderson IC, et al. Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer [erratum in JAMA. 2006;295:2356]. JAMA (2006) 295(14):1658–1667.
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J Natl Cancer Inst 2008 100: 680-681.
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