title: Impact of neoadjuvant chemotherapy in stage II-III triple negative breast cancer on eligibility for breast-conserving surgery and breast conservation rates: surgical results from CALGB 40603 (Alliance).
abstract: OBJECTIVE
  To assess the efficacy of neoadjuvant systemic therapy (NST) at increasing the rate of successful breast-conserving therapy (BCT) in triple negative breast cancer.
  
  
  BACKGROUND
  Inducing tumor regression to permit BCT is often cited to support administration of NST. To quantify this benefit, we conducted a surgical companion study to CALGB40603, a randomized phase II, 2×2 factorial trial of neoadjuvant paclitaxel ± carboplatin ± bevacizumab (B) followed by doxorubicin plus cyclophosphamide ± B in stage II-III triple negative breast cancer.
  
  
  METHODS
  Before and after NST, treating surgeons evaluated BCT candidacy by clinico-radiographic criteria; surgery performed was at surgeon and patient discretion. We measured (1) conversion rates from BCT-ineligible to BCT-eligible, (2) surgical choices in BCT candidates, and (3) rates of successful BCT with tumor-free margins.
  
  
  RESULTS
  Four hundred four patients were assessable for surgical outcomes. Two hundred nineteen (54%) were BCT candidates before NST. One hundred ninety-seven (90%) remained BCT candidates after NST, of whom 138 (70%) chose BCT, which was successful in 130 (94%). Of 185 (46%) who were not BCT candidates before NST, 78 (42%) converted to candidates with NST. Of these, 53 (68%) chose BCT with a 91% (48/53) success rate. The overall BCT-eligibility rate rose from 54% to 68% (275/404) with NST. Addition of carboplatin, B, or both increased conversion rates.
  
  
  CONCLUSIONS
  This is the first study to document prospectively a 42% conversion rate from BCT-ineligible to BCT-eligible, resulting in a 14% absolute increase in BCT eligibility. BCT was successful in 93% of patients who opted for it, but 31% of BCT-eligible patients still chose mastectomy.
authors.affiliation: *Department of Surgery, Brigham and Women's Hospital, Boston, MA †Alliance Statistics and Data Center, Duke University Medical Center, Durham, NC ‡Department of Medical Oncology Women and Infants Hospital and Alpert Medical School of Brown University, Providence, RI §Alliance Statistics and Data Center, MD Anderson Cancer Center, Houston, TX ¶Department of Medical Oncology, Maine Center for Cancer Medicine, Scarborough, ME ∥Department of Medical Oncology, City of Hope Medical Center, Los Angeles, CA **Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY ††Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; and ‡‡Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Mehra
authors.initials: M
authors.lastname: Golshan
authors.forename: Constance T
authors.initials: CT
authors.lastname: Cirrincione
authors.forename: William M
authors.initials: WM
authors.lastname: Sikov
authors.forename: Donald A
authors.initials: DA
authors.lastname: Berry
authors.forename: Sara
authors.initials: S
authors.lastname: Jasinski
authors.forename: Tracey F
authors.initials: TF
authors.lastname: Weisberg
authors.forename: George
authors.initials: G
authors.lastname: Somlo
authors.forename: Clifford
authors.initials: C
authors.lastname: Hudis
authors.forename: Eric
authors.initials: E
authors.lastname: Winer
authors.forename: David W
authors.initials: DW
authors.lastname: Ollila
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D000068258:Bevacizumab; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D064726:Triple Negative Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D004317:Doxorubicin; D016190:Carboplatin; D017239:Paclitaxel