Correlation between adverse reactions and curative effect in neoadjuvant chemotherapy for breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LI An , NIU Guifen , LI Jieqing , XIAO Wanyi , ZHAI Jinduo , LIU Chang

Department of Breast Surgery, Shenyang Fourth People's Hospital, Shenyang 110004, P. R. China;

Corresponding author：

LI An, Email: 15940315965@163.com

Keywords：

neoadjuvant chemotherapy; adverse reaction; efficacy

DOI：

10.7507/1007-9424.201903061

Video：

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Objective To analyze the relationship between adverse reactions and curative effect in neoadjuvant chemotherapy, this study is to explore whether the adverse reactions of chemotherapy can indirectly predict the efficacy of chemotherapy, so as to give a new definition of adverse reactions of chemotherapy.Methods The clinical data of 64 patients with neoadjuvant chemotherapy for breast cancer (after 4 cycles of TAC regimen) were retrospectively analyzed. The adverse reactions (weakness, nausea, vomiting, alopecia, myelosuppression, cardiotoxicity) during chemotherapy were counted. At the same time, the evaluation of chemotherapy efficacy was carried out according to the RECIST1.1 standard, and the relationship between the degree of adverse reactions of chemotherapy and the curative effect was analyzed one by one. Then, according to the severity of adverse reactions, adopting the form of scoring to assign the value, and use Pearson correlation analysis to clarify the specific relationship between adverse reactions and curative effect. Finally, four subgroups of Luminal A, Luminal B, Her2⁺ and Sanyin were determined according to molecular typing, and the relationship between adverse reactions and therapeutic effects among different subgroups was analyzed.Results There was no difference in the adverse reactions of chemotherapy in neoadjuvant chemotherapy patients of different ages (correlation coefficient r fluctuated between –0.079 and –0.164, P value fluctuated between 0.195 and 0.533). The patients with high scores of adverse reactions showed relatively good efficacy (r=0.587, P<0.01). There was no significant correlation between fatigue, nausea and vomiting and efficacy (r=0.199, P=0.144; r=0.127, P=0.144). Among the adverse reactions, there was a significant positive correlation between alopecia, myelosuppression, cardiotoxicity and efficacy (r=0.532, r=0.621, r=0.422, all P<0.01). The above correlation was verified in the Luminal A subgroup (r=0.559, P<0.007).Conclusions The severity of adverse reactions in neoadjuvant chemotherapy can predict the efficacy of chemotherapy. To a certain extent, the heavier adverse reactions, the better the chemotherapy effect. Hair loss, myelosuppression, and cardiotoxicity have a clearer effect on efficacy in several common adverse reactions.

Citation： LI An, NIU Guifen, LI Jieqing, XIAO Wanyi, ZHAI Jinduo, LIU Chang. Correlation between adverse reactions and curative effect in neoadjuvant chemotherapy for breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(8): 954-958. doi: 10.7507/1007-9424.201903061 Copy

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25.	Bisso A, Faleschini M, Zampa F, et al. Oncogenic miR-181a/b affect the DNA damage response in aggressive breast cancer. Cell Cycle, 2013, 12(11): 1679-1687.

1. 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2017 版). 中国癌症杂志, 2017, 27(9): 695-698.
2. 胡夕春, 王碧云, 邵志敏. 2011 年《St.Gallen 共识》与中国抗癌协会, 乳腺癌专业委员会指南之比较. 中华乳腺病杂志 (电子版), 2011, 5(4): 404-407.
3. Chavez-Macgregor M, Clarke CA, Lichtensztajn DY, et al. Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol, 2016, 2(3): 322-329.
4. Palmieri C, Jones A. The 2011 EBCTCG pllychemotherapy overview. Lancet, 2012, 379(9814): 390-392.
5. Perou CM, Sorlie T, Eisen MB, et al. Molecular portraits of human breast tumours. Nature, 2000, 406(6797): 747-752.
6. Sørlie T, Perou CM, Tibshirani R, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA, 2001, 98(19): 10869-10874.
7. van't Veer LJ, Dai H, van de Vijver MJ, et al. Gene expression profiling predicts clinical outcome of breast cancer. Nature, 2002, 415(6871): 530-536.
8. 美国东部肿瘤协作组. 体能状态评分 ECOG 评分法. 中华普通外科文献 (电子版), 2012, 6(6): 556.
9. Common Terminology Criteria for Adverse Events (CTCAE) v4.0. June 14, 2010. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm.
10. Trotti A, Colevas AD, Setser A, et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol, 2003, 13(3): 176-181.
11. 中国临床肿瘤学会指南工作委员会. 肿瘤放化疗相关中性粒细胞减少症规范化管理指南. 中华肿瘤杂志, 2017, 39(11): 868-878.
12. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer, 2009, 45(2): 228-247.
13. Berruti A, Amoroso V, Gallo F, et al. Pathologic complete response as a potential surrogate for the clinical outcome in patients with breast cancer after neoadjuvant therapy: a meta-regression of 29 randomized prospective studies. J Clin Oncol, 2014, 32(34): 3883-3891.
14. Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet Lond Engl, 2014, 384(9938): 164-172.
15. Gralow JR, Brustein HJ, Wood W, et al. Preoperative therapy in invasive braast cancer: pathologic assessment and systemic therapy issuses in operable disease. J Clin Oncol, 2008, 26(5): 814-819.
16. Kaufmann M, von Minckwitz G, Bear HD, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer:new perspectives 2006. Ann Oncol, 2007, 18(12): 1927-1934.
17. Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst, 2005, 97(3): 188-194.
18. 张玲菡, 柳梅, 龚灿, 等. 新辅助化疗后乳腺癌保乳手术问题现状. 中国普外基础与临床杂志, 2018, 25(2): 154-160.
19. Esteva FJ, Hortobagyi GN. Can early response assessment guide neoadjuvant chemotherapy in early-stage breast cancer? J Natl Cancer Inst, 2008, 100(8): 521-523.
20. 谭龙涛, 滕晓飞, 程凯, 等. 乳腺癌新辅助化疗疗效生物学预测指标的研究进展. 中国普外基础与临床杂志, 2017, 24(12): 1546-1550.
21. Thomas E, Holmes FA, Smith TL, et al. The use of alternate, non-cross-resistant adjuvant chemotherapy on the basis of pathologic response to a neoadjuvant doxorubicin-based regimen in women with operable breast cancer: long-term results from a prospective randomized trial. J Clin Oncol, 2004, 22(12): 2294-2302.
22. Volders JH, Negenborn VL, Spronk PE, et al. Breast-coserving surgery following neoadjuvant therapy systematic review on surgical outcomes. Breast cancer Res Treat, 2018, 168(1): 1-12.
23. Von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of patholocic complete response on prognosis after neoadjuvant chemotherepy in various intrinsic cancer subtypes. J Clin Oncl, 2012, 30(15): 1796-1804.
24. Banerjl S, Cibulskis K, Rangel-Escareno C, et al. Sequence analysis of mutations and translocations across breast cancer subtypes. Nature, 2012, 486(7403): 405-409.
25. Bisso A, Faleschini M, Zampa F, et al. Oncogenic miR-181a/b affect the DNA damage response in aggressive breast cancer. Cell Cycle, 2013, 12(11): 1679-1687.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Correlation between adverse reactions and curative effect in neoadjuvant chemotherapy for breast cancer

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