“It’s a small quintile of patients that’s still at fairly substantial risk.” Symmans said that in the hormone receptor–negative/HER2-positive group, the 69% rate of pathologic complete response was “striking” and “illustrates how effective these current treatments are.” The 20% of patients who were classified as RCB-II and RCB-III had significantly worse survival than the others. The residual cancer burden index values were associated with 5-year and 10-year event-free survival, as shown in Table 1.Įlaborating on what emerged from the four subgroups, Dr. “The implication is that you can take an individual patient’s score representing how much residual cancer she has and calibrate that to an accurate estimate of her risk over time.”Ī pathologic complete response (RCB-0) was most likely to be achieved by hormone receptor–negative/HER2-positive patients (69%) and least likely by the hormone receptor–positive/HER2-negative group (11%) the triple-negative group (43%) and hormone receptor–positive/HER2-positive group (38%) fell in between. “The most interesting result, in my opinion, is that you see a log-linear relationship for the index score and survival,” Dr. This finding was consistent across 12 clinical sites and all cancer subtypes. The residual cancer burden index was tightly associated with both event-free and distant disease–free survival. Relationship Between Residual Cancer Burden and Prognosis For each subtype, a multivariate analysis adjusted for patient age, tumor size, nodal status, and grade. The study examined the relationship between the continuous residual cancer burden index and event-free survival, as well as distant relapse–free survival for four breast cancer phenotypes: hormone receptor–negative/HER2-negative (triple-negative), hormone receptor–negative/HER2-positive, hormone receptor–positive/HER2-positive, and hormone receptor–positive/HER2-negative. The pooled analysis came from the I-SPY Clinical Trials Consortium, involving 12 institutions or clinical trials and encompassing 5,160 patients. The website offers instructional videos, protocols, illustrations, and diagrams as resources for the pathologists who use it. The online calculator page receives about 16,000 visits per month, “so it’s being used out there,” he noted. This is just organizing what we would otherwise report in pathology, but we’re doing it in a quantitative and standardized manner.” “Then, we combine that with the fraction of that area that still contains invasive cancer cells, as well as the number of positive lymph nodes and the size of the largest metastasis. The residual cancer burden calculator is available to all pathologists through an online calculator ( “The basic principle is that we estimate the area that still contains residual disease, map that area to the slides that we’ll be looking at under the microscope, and create an image so that we can reconstruct it and be able to determine what area still contains actual cancer,” Dr.For all subtypes, residual cancer burden tracked consistently with long-term outcome.The index has a log-linear relationship with event-free survival at 5 and 10 years.The residual cancer burden index categorizes patients with breast cancer into four groups (RCB 0–IV) based on level of residual disease after neoadjuvant therapy and several other factors as assessed by pathologists.This is then categorized into one of the following three classes: RCB-I (minimal burden), RCB-II (moderate burden), and RCB-III (extensive burden). Investigators at The University of Texas MD Anderson Cancer Center put these factors together to develop a residual cancer burden calculator, which computes an index and allocates a classification of pathologic complete response (A value of 0 equates to a pathologic complete response. He explained that pathologists calculate residual cancer burden from multiple factors: primary tumor area, percentage of the tumor area that is invasive cancer, and extent of lymph node involvement. “This is really about organizing the workflow in pathology to standardize how we evaluate response after neoadjuvant treatment,” Dr. “There is a generally linear relationship between index value and the log of risk.” “The most important conclusion is that there is a strong potential to calibrate an individual’s index score to her residual prognostic risk,” Dr. This study, however, goes a step further in estimating the long-term prognosis for each class of residual cancer burden across breast cancer subtypes. This is not the first study to show residual cancer burden to be an independent factor for prognosis after neoadjuvant chemotherapy.
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