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Early assessment with magnetic resonance imaging for prediction of pathologic response to neoadjuvant chemotherapy in triple-negative breast cancer: Results from the phase III BrighTNess trial

Mehra Golshan, Stephanie M Wong, Sibylle Loibl, Jens Huober, Joyce O'Shaughnessy, Hope S Rugo, Norman Wolmark, Peter Ansell, David Maag, Danielle M Sullivan, Otto Metzger-Filho, Gunter Von Minckwitz, Charles E Geyer, William M Sikov & Michael Untch

abstract

INTRODUCTION
The ability of breast magnetic resonance imaging (MRI) to predict pathologic complete response (pCR) to neoadjuvant systemic therapy (NST) varies across biological subtypes. We sought to determine how well breast MRI findings following initial treatment on the phase III BrighTNess trial correlated with pCR in patients with triple negative breast cancer (TNBC).

METHODS
Baseline and mid-treatment imaging and pathologic response data were available in 519 patients with stage II-III TNBC who underwent NST as per protocol. MRI complete response (mCR) was defined as disappearance of all target lesion(s) and MRI partial response (mPR) as a ≥50% reduction in the largest tumor diameter.

RESULTS
Overall, mCR was demonstrated in 116 patients (22%), whereas 166 (32%) had mPR and 237 (46%) had stable/progressive disease (SD/PD). The positive predictive value (PPV), negative predictive value, and overall accuracy of the mid-treatment MRI for pCR were 78%, 56%, and 61%, respectively; accuracy did not differ significantly between gBRCA mutation carriers and non-carriers (52% vs. 63%, p = 0.10). When compared to patients with SD/PD, those with mPR or mCR were 3.35-fold (95% CI 2.07-5.41) more likely to have pCR at surgery. MRI response during NST was significantly associated with eligibility for breast-conserving surgery following completion of treatment (93.1% for mCR vs. 81.6% for SD/PD, p < 0.001).

CONCLUSIONS
Complete response on mid-treatment MRI in the BrighTNess trial had a PPV of 78% for demonstration of pCR after completion of NST in TNBC. However, a substantial proportion of patients with mPR or SD/PD also achieved a pCR.

CLINICAL TRIAL REGISTRATION
NCT02032277.
   
citation Golshan M, Wong S M, Loibl S, Huober J, O'Shaughnessy J, Rugo H S, Wolmark N, Ansell P, Maag D, Sullivan D M, Metzger-Filho O, von Minckwitz G, Geyer C E, Sikov W M, Untch M. Early assessment with magnetic resonance imaging for prediction of pathologic response to neoadjuvant chemotherapy in triple-negative breast cancer: Results from the phase III BrighTNess trial. Eur J Surg Oncol 2019; 46:223-228.
   
type journal paper/review (English)
date of publishing 05-10-2019
journal title Eur J Surg Oncol (46/2)
ISSN electronic 1532-2157
pages 223-228
PubMed 31606288
DOI 10.1016/j.ejso.2019.10.002