Changing the role of pCR in breast cancer treatment - an unjustifiable interpretation of a good prognostic factor as a “factor for a good prognosis“

Frontiers in Oncology

Oncology

Katarina Zecic¹  Milan Gojgic²  Barbara Loboda²  Ognjen Zecic²  Dragana Bjelica²  Simona Petricevic²  Darko Zdravkovic³  Nebojsa Ivanovic³  Natasa Colakovic³  Masan Bogdanovski⁴ 

[1] Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Belgrade, Serbia;Department of Surgical Oncology, University Hospital Medical Center (UHMC) “Bezanijska kosa”, Belgrade, Serbia;Department of Surgical Oncology, University Hospital Medical Center (UHMC) “Bezanijska kosa”, Belgrade, Serbia;Department of Surgery, Faculty of Medicine, University of Belgrade, Belgrade, Serbia;Faculty of Philosophy, Department of Philosophy, University of Belgrade, Belgrade, Serbia;

关键词: early breast cancer;    pathologic complete response;    neoadjuvant systemic therapy;    adjuvant systemic therapy;    prognostic factor;    treatment guidelines;   

DOI  :  10.3389/fonc.2023.1207948

 received in 2023-04-18, accepted in 2023-07-03,  发布年份 2023

来源: Frontiers

【 摘 要 】

Pathologic complete response (pCR) after neoadjuvant systemic therapy (NAST) of early breast cancer (EBC) has been recognized as a good prognostic factor in the treatment of breast cancer because of its significant correlation with long-term disease outcome. Based on this correlation, pCR has been accepted by health authorities (FDA, EMA) as a surrogate endpoint in clinical trials for accelerated drug approval. Moreover, in recent years, we have observed a tendency to treat pCR in routine clinical practice as a primary therapeutic target rather than just one of the pieces of information obtained from clinical trials. These trends in routine clinical practice are the result of recommendations in treatment guidelines, such as the ESMO recommendation “…to deliver all planned (neoadjuvant) treatment without unnecessary breaks, i.e. without dividing it into preoperative and postoperative periods, irrespective of the magnitude of tumor response”, because “…this will increase the probability of achieving pCR, which is a proven factor for a good prognosis…”. We hypothesize that the above recommendations and trends in routine clinical practice are the consequences of misunderstanding regarding the concept of pCR, which has led to a shift in its importance from a prognostic factor to a desired treatment outcome. The origin of this misunderstanding could be a strong subconscious incentive to achieve pCR, as patients who achieved pCR after NAST had a better long-term outcome compared with those who did not. In this paper, we attempt to prove our hypothesis. We performed a comprehensive analysis of the therapeutic effects of NAST and adjuvant systemic therapy (AST) in EBC to determine whether pCR, as a phenomenon that can only be achieved at NAST, improves prognosis per se. We used published papers as a source of data, which had a decisive influence on the formation of the modern attitude towards EBC therapy. We were unable to find any evidence supporting the use of pCR as a desired therapeutic goal because NAST (reinforced by pCR) was never demonstrated to be superior to AST in any context.

【 授权许可】

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Copyright © 2023 Ivanovic, Bjelica, Loboda, Bogdanovski, Colakovic, Petricevic, Gojgic, Zecic, Zecic and Zdravkovic