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Master Thesis

Facteurs prédictifs de rechute locorégionale après chimiothérapie néoadjuvante dans les cancers du sein : analyse rétrospective de l’étude prospective EORTC 10994/BIG 1-00

Abstract : Purpose: neoadjuvant chemotherapy is now the gold standard treatment of locally advanced breast cancers. Clinical and pathological predictive factors of locoregional recurrence (LRR) must be identified to guide the adjuvant radiotherapy decisions. The objective of this thesis is, after a review of the literature, to identify those factors through the analysis of a multicentric phase III trial (EORTC 10994). Methods: patients received neoadjuvant chemotherapy, surgery and adjuvant radiotherapy. Some of the patients with HER2 (Human Epidermal growth factor Receptor 2) positive cancer also received adjuvant trastuzumab. A multivariate analysis was used to identify predictive factors of LRR. The primary endpoint was time to LRR as first event. Results: the median follow-up was 4.8 years. In 1553 eligible patients, 76 LRR occurred, with a 5-year cumulative incidence of 4.9% (95% CI [3.76-6.04]). In multivariate analysis, breast cancer subtype was a significant predictor of LRR (p<0.0001), with Hazard Ratio (HR) of 6.44 (95% CI [2.83-14.69]) for triple negative, 6.26 (95% CI [2.81-13.93]) for HER2+ without trastuzumab (T), and 3.37 (95% CI [1.10-10.34]) for HER2+ with T cancers. Pathological response was also associated with significantly higher risk of LRR in case of ≥ 4 pathologically positive nodes, HR 2.43 (95% CI [1.34-4.40], p<0.0001). Age, cT and cN status, histological type, type of surgery and surgical margins were not significant predictors. Conclusion: breast cancer subtype (HER2+ and triple negative) and pathological response are predictive factors of LRR after neoadjuvant chemotherapy. Other studies are required to identify a subgroup of patients with low risk of LRR and for whom adjuvant radiotherapy would not be mandatory.
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Master Thesis
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Pauline Gillon. Facteurs prédictifs de rechute locorégionale après chimiothérapie néoadjuvante dans les cancers du sein : analyse rétrospective de l’étude prospective EORTC 10994/BIG 1-00. Médecine humaine et pathologie. 2016. ⟨dumas-01447110⟩

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