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Considering the histological classification, a higher prevalence of positive Ki67 proliferation index was found in cases achieving the pathological response [5/7 (71%) pCR vs. 11/35 (31%) non-pCR]; a positive pERK1-2 expression was instead observed in patients who did not achieve the pathological response [0/8 pCR vs. 5/45 (11%) non-pCR] (Table 3).
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However, less than half of the patients achieve complete pathological response after preoperative chemoradiotherapy (Huerta et al, 2009).
Now we have evidence that, the higher the levels of EGFR, the higher the probability to achieve pathological complete response from cetuximab- or panitumumab-based therapy in the neoadjuvant setting [ 74].
Existing studies show that the patients who benefit the most from neoadjuvant chemotherapy are those who achieve a pathological complete response (pCR) with no residual microscopic tumour.
Importantly, neoadjuvant chemotherapy has been found to be as efficacious as chemotherapy given in the adjuvant setting, and patients who achieve complete pathological response after neoadjuvant intervention generally have an excellent probability of experiencing long-term survival [ 13- 15].
The ideal functional imaging test would accurately identify patients who are unlikely to achieve a pathological complete response after chemoradiotherapy and would aid the delineation of a biological target volume that could be used for treatment intensification.
HER2-positive breast cancers are more likely to achieve a pathological complete response (defined as absence of invasive tumour in the final excision specimen allowing for the presence of DCIS).
In these studies only those patients who failed to achieve a pathological complete remission could be evaluated because estimates of Ki67 in the excision biopsy were required.
However, patients with the greatest reduction in cell proliferation after chemotherapy were more likely to achieve a pathological response.
BRCA1 mutation carriers are more likely to achieve a pathological complete response with DNA-damage-based chemotherapy compared to non-mutation carriers.
However, patients with the greatest reductions in tumour cell proliferation on completion of chemotherapy were most likely to achieve a pathological response.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com