Predictors of Response to Preoperative Chemotherapy in Her2-positive Breast Cancer Patients Open Access

Zelnak, Amelia (2009)

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Predictors of Response to Preoperative Chemotherapy in Her2-positive
Breast Cancer Patients
By Amelia B. Zelnak
Objective. The aim of this study was to determine the pathologic complete response rate (pCR)
to preoperative, trastuzumab-based chemotherapy in Her2-positive, early-stage breast cancer
patients and to determine predictors of pCR.
Methods. This is a retrospective study of 27 women with early-stage, Her2-positive breast
cancer who received preoperative, trastuzumab-based chemotherapy. Analysis of predictor
variables was performed using multivariate logistic regression.
Findings. A total of 27 patients were included in this analysis. The overall pCR rate among
early-stage Her2-positive breast cancer patients receiving trastuzmab-based preoperative
chemotherapy was 66.7%. The pCR rate among patients treated as part of phase II clinical trial
was 63.6%. In univariate analysis, no statistically significant association was seen between the
following predictor variables and pCR: tumor size, estrogen receptor (ER) status, anthracycline-
based chemotherapy, high nuclear grade, age, clinical nodal status, and body mass index. In
multivariate analysis, no association was seen between the predictor variables and pCR.
Conclusions. This study did not identify any variables that predicted having a pathologic
complete response to preoperative chemotherapy among Her2-positive patients. The pCR rate
was higher than previously seen in clinical trials, and implies that the most significant predictor of
pCR to preoperative trastuzumab-based chemotherapy is being Her2-positive.

Table of Contents


I. Introduction
II. Background
III. Methods
IV. Results
V. Discussion
VI. References
a. Table 1. Baseline Patient Characteristics.
b. Table 2. Pathologic complete response (pCR) rates.
c. Table 3. Frequency of predictor variables in patients who achieved pathologic
complete response (pCR) versus those who did not achieve pCR.
d. Table 4. Predictive factors of pathologic complete response in univariate
e. Table 5. Predictive factors of pathologic complete response in multivariate
logistic regression analysis.
f. Table 6. Significant Correlation Between Age and Menopausal Status, and Age
and ER Status.
g. Table 7. Predictive Factor Analysis for pathologic complete response for the
Multivariate Model excluding Age due to Collinearity with ER Status and
Menopausal Status
a. Appendix 1. Study schema for phase II preoperative clinical trial of nab-
paclitaxel and trastuzumab followed by vinorelbine and trastuzumab.
b. Appendix 2. Inclusion and Exclusion Criteria for phase II preoperative trial.

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