The neoadjuvant model and complete pathologic response in breast cancer: All or nothing?
A partir d'une revue de la littérature publiée jusqu'en décembre 2014 (36 études), cette méta-analyse évalue, en fonction du statut des récepteurs hormonaux de la tumeur, l'association entre la réponse pathologique complète à un traitement néoadjuvant et la survie sans événement ou la survie globale à long terme chez les patientes atteintes d'un cancer du sein HER2+ (5 768 cas)
With neoadjuvant therapy, response to treatment can potentially be assessed after months rather than years of follow-up. Pathologic complete response (pCR) to neoadjuvant therapy, defined as complete eradication of invasive cancer from the breast and lymph nodes, directly reflects a drug’s cytotoxic activity against the tumor and is typically associated with excellent patient survival. An important question is whether pCR is a good surrogate end point for long-term survival. Evidence from recent large meta-analysis studies has unequivocally answered yes, at the individual patient level. If a patient achieves pCR, the risk of relapse is low and her long-term survival is excellent, irrespective of disease subtype or the type of neoadjuvant chemotherapy that she received.1,2 However, the answer to the subtly different question as to whether increases in pCR rate resulting from an effective treatment translate to improved survival benefit for the patients who received that treatment has been more contradictory.3- 5 Although pCR is established as an individual-level surrogate end point, it has not yet been universally accepted as a general trial-level surrogate end point for selecting effective therapies from randomized clinical trials or as a screening end point to eliminate ineffective treatments in the neoadjuvant setting.5 Yet, because pCR correlates most strongly with survival outcomes in the more aggressive subtypes1—triple negative and ERBB2 positive—it is possible that pCR could be an acceptable trial-level surrogate end point for these specific subtypes.
JAMA Oncology , commentaire, 2015