Pathologic complete response as a potential surrogate for the clinical outcome in patients with breast cancer after neoadjuvant therapy: A meta-regression of 29 randomized prospective studies

Alfredo Berruti, Vito Amoroso, Fabio Gallo, Valentina Bertaglia, Edda Simoncini, Rebecca Pedersini, Laura Ferrari, Alberto Bottini, Paolo Bruzzi, Maria Pia Sormani

Research output: Contribution to journalArticle

Abstract

Purpose: To assess the role of pathologic complete response (pCR) after neoadjuvant therapy as surrogate end point of disease-free survival (DFS) and overall survival (OS) in patients with breast cancer, we performed a trial-based meta-regression of randomized studies comparing different neoadjuvant systemic treatments. Methods: The systematic literature search included electronic databases and proceedings of oncologic meetings. Endocrine therapy trials were excluded. Treatment effects on DFS and OS were expressed as hazard ratios (HRs), and treatment effects on pCR were expressed as odds ratios (ORs). A weighted regression analysis was performed on log-transformed treatment effect estimates to test the association between treatment effects on the surrogate outcome and treatment effects on the clinical outcome. Results: Twenty-nine trials, 59 arms, and 30 comparisons, for a total of 14,641 patients, were included in the analysis. Using the complete set of data, the regression of either the log(HR) for DFS or the log(HR) for OS on the log(OR) for pCR demonstrated only weak associations (R2 = 0.08; 95% CI, 0 to 0.47; and R2 = 0.09; 95% CI, 0.01 to 0.41, respectively). Better associations were found in an exploratory analysis assessing a subset of trials comparing intensified/dose-dense chemotherapy versus standard-dose regimens (DFS: R2 = 0.79; 95% CI, 0.26 to 0.95; P = .003; and OS: R2 = 0.57; 95% CI, 0.19 to 0.93; P = .03). Conclusion: This meta-regression analysis of 29 heterogeneous neoadjuvant trials does not support the use of pCR as a surrogate end point for DFS and OS in patients with breast cancer. However, pCR may potentially meet the criteria of surrogacy with specific systemic therapies.

Original languageEnglish
Pages (from-to)3883-3891
Number of pages9
JournalJournal of Clinical Oncology
Volume32
Issue number34
DOIs
Publication statusPublished - Dec 1 2014

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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