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Title: High Proliferation Predicts Pathological Complete Response to Neoadjuvant Chemotherapy in Early Breast Cancer.
Authors: Alba, Emilio
Lluch, Ana
Ribelles, Nuria
Anton-Torres, Antonio
Sanchez-Rovira, Pedro
Albanell, Joan
Calvo, Lourdes
García-Asenjo, Jose Antonio Lopez
Palacios, Jose
Chacon, Jose Ignacio
Ruiz, Amparo
De la Haba-Rodriguez, Juan
Segui-Palmer, Miguel A
Cirauqui, Beatriz
Margeli, Mireia
Plazaola, Arrate
Barnadas, Agusti
Casas, Maribel
Caballero, Rosalia
Carrasco, Eva
Rojo, Federico
Keywords: Breast cancer;Chemosensitivity;Ki67;Neoadjuvant chemotherapy;Predictive factor
metadata.dc.subject.mesh: Adult
Breast Neoplasms
Clinical Trials as Topic
Disease-Free Survival
Estrogen Receptor alpha
Ki-67 Antigen
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Predictive Value of Tests
Receptor, ErbB-2
Issue Date: 19-Jan-2016
Abstract: In the neoadjuvant setting, changes in the proliferation marker Ki67 are associated with primary endocrine treatment efficacy, but its value as a predictor of response to chemotherapy is still controversial. We analyzed 262 patients with centralized basal Ki67 immunohistochemical evaluation derived from 4 GEICAM (Spanish Breast Cancer Group) clinical trials of neoadjuvant chemotherapy for breast cancer. The objective was to identify the optimal threshold for Ki67 using the receiver-operating characteristic curve method to maximize its predictive value for chemotherapy benefit. We also evaluated the predictive role of the defined Ki67 cutoffs for molecular subtypes defined by estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2). A basal Ki67 cutpoint of 50% predicted pathological complete response (pCR). Patients with Ki67 >50% achieved a pCR rate of 40% (36 of 91) versus a pCR rate of 19% in patients with Ki67 ≤ 50% (33 of 171) (p = .0004). Ki67 predictive value was especially relevant in ER-HER2- and ER-HER2+ patients (pCR rates of 42% and 64%, respectively, in patients with Ki67 >50% versus 15% and 45%, respectively, in patients with Ki67 ≤ 50%; p = .0337 and .3238, respectively). Both multivariate analyses confirmed the independent predictive value of the Ki67 cutpoint of 50%. Basal Ki67 proliferation index >50% should be considered an independent predictive factor for pCR reached after neoadjuvant chemotherapy, suggesting that cell proliferation is a phenomenon closely related to chemosensitivity. These findings could help to identify a group of patients with a potentially favorable long-term prognosis. The use of basal Ki67 status as a predictive factor of chemotherapy benefit could facilitate the identification of a patient subpopulation with high probability of achieving pathological complete response when treated with primary chemotherapy, and thus with a potentially favorable long-term prognosis.
metadata.dc.identifier.doi: 10.1634/theoncologist.2015-0312
Appears in Collections:Producción 2020

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