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Analyzing Predictors of Response to Neoadjuvant Chemotherapy in Breast Cancer

Angela DeMichele, MD, MSCE
Published Online:3:41 PM, Wed September 4, 2019

Angela DeMichele, MD, MSCE, coleader of the Breast Cancer Research Program, and director of the Breast Cancer Clinical Trials Unit at the University of Pennsylvania’s Abramson Cancer Center, discusses predictors of response to neoadjuvant chemotherapy in various subgroups of patients with breast cancer. Selecting characteristics of patients who will most likely benefit from this therapy is not an exact science, she adds.

In patients with HER2-positive breast cancer, a multi-agent neoadjuvant chemotherapy regimen can be given to any patient with HER2 expression of 3 or more on immunohistochemistry or who are FISH positive. These patients may also benefit from an adjuvant HER2-directed therapy as well, DeMichele says.

For patients with triple-negative breast cancer (TNBC), there are no selection markers to predict which patients will respond to adjuvant chemotherapy. DeMichele advises that all patients with TNBC be given neoadjuvant chemotherapy to see if they respond.

In the subgroup of patients with estrogen receptor (ER)–positive disease, oncologists do have some guidance as to which patients may respond. Molecular predictors, such as MammaPrint and Ki-67, can help in determining which patients with ER-positive disease will be responsive to neoadjuvant chemotherapy and who is less likely to respond. Overall, markers of response are emerging to help make these decisions for patients with ER-positive breast cancer.
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