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Risk assessment after neoadjuvant chemotherapy in luminal breast cancer using a clinicomolecular predictor

Purpose: This study aimed to evaluate a modified EPclin test (mEPclin), a combination of EndoPredict (EP) score, post-neoadjuvant pathologic tumor size and nodal status, for predicting the risk of distance recurrence after neoadjuvant chemotherapy (NACT) in patients with residual estrogen receptor (...

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Main Authors: Loibl, Sibylle (Author) , Weber, Karsten (Author) , Huober, Jens (Author) , Krappmann, Kristin (Author) , Marmé, Frederik (Author) , Schem, Christian (Author) , Engels, Knut (Author) , Pfitzner, Berit Maria (Author) , Kümmel, Sherko (Author) , Furlanetto, Jenny (Author) , Hartmann, Arndt (Author) , Darb-Esfahani, Silvia (Author) , Müller, Volkmar (Author) , Staebler, Annette (Author) , Minckwitz, Gunter von (Author) , Kronenwett, Ralf (Author) , Denkert, Carsten (Author)
Format: Article (Journal)
Language:English
Published: April 4, 2018
In: Clinical cancer research
Year: 2018, Volume: 24, Issue: 14, Pages: 3358-3365
ISSN:1557-3265
DOI:10.1158/1078-0432.CCR-17-2947
Online Access:Verlag, Volltext: https://doi.org/10.1158/1078-0432.CCR-17-2947
Verlag: https://clincancerres.aacrjournals.org/content/24/14/3358
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Author Notes:Sibylle Loibl, Karsten Weber, Jens Huober, Kristin Krappmann, Frederik Marmé, Christian Schem, Knut Engels, Berit Maria Pfitzner, Sherko Kümmel, Jenny Furlanetto, Arndt Hartmann, Silvia Darb-Esfahani, Volkmar Müller, Annette Staebler, Gunter von Minckwitz, Ralf Kronenwett, and Carsten Denkert
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Summary:Purpose: This study aimed to evaluate a modified EPclin test (mEPclin), a combination of EndoPredict (EP) score, post-neoadjuvant pathologic tumor size and nodal status, for predicting the risk of distance recurrence after neoadjuvant chemotherapy (NACT) in patients with residual estrogen receptor (ER)-positive/HER2-negative breast cancer. We also compared the prognostic power of the mEPclin with that of the CPS-EG score. - Experimental Design: A total of 428 formalin-fixed, paraffin-embedded tumor samples from GeparTrio and GeparQuattro studies were evaluated for mRNA expression of eight cancer-related and three reference genes. The mEPclin score was computed using a modified algorithm and predefined cut-off values were used to classify each patient at low or high risk. Primary endpoint was disease-free survival (DFS). - Results: A higher continuous mEPclin score was significantly associated with increased risk of relapse [HR, 2.16; 95% confidence interval (CI), 1.86-2.51; P < 0.001] and death (HR, 2.28; 95% CI, 1.90-2.75; P < 0.001). Similarly, patients classified at high risk by dichotomous mEPclin showed significantly poorer DFS and overall survival compared with those at low risk. In contrast with CPS-EG, the mEPclin remained significantly prognostic for DFS in multivariate analysis (HR, 2.13; 95% CI, 1.73-2.63; P < 0.001). Combining CPS-EG and other clinicopathological variables with mEPclin yielded a significant improvement of the prognostic power for DFS versus without mEPclin (c-indices: 0.748 vs. 0.660; P < 0.001). - Conclusions: The mEPclin score independently predicted the risk of distance recurrence and provided additional prognostic information to the CPS-EG score to assess more accurately the prognosis after NACT in the luminal non-pCR patient population. Therefore, this approach can be used to select patients for additional post-neoadjuvant therapies. Clin Cancer Res; 24(14); 3358-65. ©2018 AACR.
Item Description:Gesehen am 27.02.2020
Physical Description:Online Resource
ISSN:1557-3265
DOI:10.1158/1078-0432.CCR-17-2947

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