title: Neoadjuvant chemotherapy adaptation and serial MRI response monitoring in ER-positive HER2-negative breast cancer.
abstract: BACKGROUND
  Changing the neoadjuvant chemotherapy regimen in insufficiently responding breast cancer is not a standard policy. We analysed a series of patients with 'luminal'-type breast cancer in whom the second half of neoadjuvant chemotherapy was selected based on the response to the first half.
  
  
  METHODS
  Patients with oestrogen receptor-positive (ER+) human epidermal growth factor receptor 2-negative (HER2-) breast cancer received three courses of neoadjuvant dose-dense doxorubicin and cyclophosphamide (ddAC). Three further courses of ddAC were administered in case of a 'favourable response' on the interim magnetic resonance imaging (MRI) and a switch to docetaxel and capecitabine (DC) was made in case of an 'unfavourable response', using previously published response criteria. The efficacy of this approach was evaluated by tumour size reductions on serial contrast-enhanced MRI, pathologic response and relapse-free survival.
  
  
  RESULTS
  Two hundred and forty-six patients received three courses of ddAC. One hundred and sixty-four patients (67%) had a favourable response at the interim MRI, with a mean tumour size reduction of 31% after the first three courses and 34% after the second three courses. Patients with unfavourable responsive tumours had a mean tumour size reduction of 12% after three courses and received three courses of DC rather than ddAC. This led to a mean shrinkage of 27%.
  
  
  CONCLUSIONS
  The tumour size reduction of initially less responsive tumours after treatment adaptation adds further evidence that a response-adapted strategy may enhance the efficacy of neoadjuvant chemotherapy.
authors.affiliation: Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066, The Netherlands.
authors.forename: L S
authors.initials: LS
authors.lastname: Rigter
authors.forename: C E
authors.initials: CE
authors.lastname: Loo
authors.forename: S C
authors.initials: SC
authors.lastname: Linn
authors.forename: G S
authors.initials: GS
authors.lastname: Sonke
authors.forename: E
authors.initials: E
authors.lastname: van Werkhoven
authors.forename: E H
authors.initials: EH
authors.lastname: Lips
authors.forename: H A
authors.initials: HA
authors.lastname: Warnars
authors.forename: P K
authors.initials: PK
authors.lastname: Doll
authors.forename: A
authors.initials: A
authors.lastname: Bruining
authors.forename: I A
authors.initials: IA
authors.lastname: Mandjes
authors.forename: M J
authors.initials: MJ
authors.lastname: Vrancken Peeters
authors.forename: J
authors.initials: J
authors.lastname: Wesseling
authors.forename: K G
authors.initials: KG
authors.lastname: Gilhuijs
authors.forename: S
authors.initials: S
authors.lastname: Rodenhuis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077143:Docetaxel; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D000069585:Filgrastim; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000096:biosynthesis*; D011960:Receptors, Estrogen / Q000096:biosynthesis; D011994:Recombinant Proteins / Q000008:administration & dosage; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000069287:Capecitabine; D003520:Cyclophosphamide; D003841:Deoxycytidine; D000077143:Docetaxel; D004317:Doxorubicin; D000069585:Filgrastim; D005472:Fluorouracil; D016179:Granulocyte Colony-Stimulating Factor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011994:Recombinant Proteins; D043823:Taxoids; C508053:ERBB2 protein, human