MRI assessment of response to treatment in NAC

Author(s): Dr E A M O'Flynn

Hospital: Institute of Cancer Research and The Royal Marsden Hospital

Reference: RAD Magazine, 41, 485, 21-22


Neoadjuvant chemotherapy (NAC) is offered to women with large, locally invasive breast tumours with an aim to downstage the tumour and enable breast conserving surgery. Traditionally it has been given to women with locally advanced disease, but increasingly now it is being offered to women with much smaller cancers and lower stage disease (IIb or IIa) to facilitate the best cosmetic surgical outcome. This is following publication of important data sets such as the NSABP B-18 trial which showed that NAC could be offered primarily as an alternative to adjuvant chemotherapy without an adverse effect on survival. A standard NAC regimen routinely involves eight cycles of treatment: Four cycles of anthracycline-based epirubicin (90mg/m2) and cyclophosphamide (600mg/m2) for 12 weeks followed by four cycles of a taxane-based therapy with paclitaxel (175mg/m2) for eight weeks (total 20 weeks). Variation in therapy regimens offered exists but the vast majority of patients will achieve some response. A subset of patients will also go on to achieve a pathological complete response (pCR) at final surgery4 with pCR rates being highest in triple negative breast cancers and HER2 subtypes. Achieving pCR is highly desirable as it is associated with improved overall and improved disease free survival.

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