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Abstract
Introduction. The role of neoadjuvant chemotherapy (NACT) in luminal B HER2-negative breast cancer (BC) is still a matter of debate, since there are no reliable data on the predictors of the effectiveness of drug therapy.
Aim. To evaluate the effectiveness of NACT in patients with luminal B HER2-negative BC and to compare modern systems for assessing the pathological response.
Materials and methods. The aim is to evaluate the tumor response to modern NACT regimens in 158 patients with luminal B, HER2-negative BC in stages II–III. The median age of the patients was 47.5 years (21–75). The primary resectable stages of the disease (cT1–3N0–1) were diagnosed in 82.1% of patients and locally advanced BC (cT1–3N2) in 17.88%. Before the start of NACT, the morphological characteristics of BC were as follows: G1-2 and G3 malignancy was noted in 47% and 38.4% of cases, respectively. The Ki-67 level ranged from 20% to 90%, with a median of 45%. In the absence of gene amplification, the HER2 status was 0, 1+ or 2+ in 66.89%, 29.49% and 6.62% of patients, respectively. Following NACT involving anthracyclines and taxanes, the patients underwent surgery (mastectomy with or without simultaneous reconstruction, or radical sectoral resection of the mammary gland), during which the tumor response to NACT was assessed.
Results. A complete pathomorphological response (pCR) was observed in 13.9% of patients, corresponding to RCB class 0 and pathomorphological stage ypT0N0. The predictors of achieving pCR in luminal B HER2-negative BC were G3 and Ki-67 >50%.
Conclusion. The level of Ki-67 > 50 %, G3 before the start of NACT will help to identify a group of patients with high sensitivity to chemotherapy. It will also help to determine which patients with luminal B HER2-negative BC should not undergo NACT.
References
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