Abstract 22P
Background
Nab-paclitaxel (Abraxane) has been reported to increase pathological complete response (pCR) more effectively than conventional paclitaxel in neoadjuvant chemotherapy (NAC). Furthermore, the neutrophil-to-lymphocyte ratio (NLR) before NAC have been reported as predictors of pCR. This study aimed to evaluate the predictive utility of NLR before NAC for pathologic response and prognosis in patients receiving Abraxane-based NAC.
Methods
A total of 142 patients whose histological responses were evaluated were included in this study. T1:44 (31.0%); T2:82 (57.7%); T3:11 (7.7%); and T4:3 (2.1%). N0:84 (59.2%); N1:51 (35.9%); N2:2 (1.4%); and N3:3 (2.1%). Hormone receptor (HR) +/ human epidermal growth factor receptor 2 (HER2) -: 6 (4%); HR + or HR -/HER2 +: 71 (50%) and HR -/HER2 -: 63 (44%). Abraxane was administered tri-weekly for four cycles, and in HER2+ cases, it was combined with trastuzumab and pertuzumab. NAC with Abraxane was followed sequentially by anthracycline containing regimen administered triweekly or biweekly for four cycles. pCR was defined as ypT0ypN0 or ypTisypN0. The cutoff value for NLR was determined to be low NLR < 2.1 and high NLR ≥ 2.1 based on ROC curve analysis.
Results
The median observation period was 55 months (range 11-130), with a clinical response rate of 93.0% (132/142, CR:76, PR: 56, SD: 8). The pCR rate was 51.4% (73/142), with rates of 16.7% (1/6) for HR+/HER2-, 43.6% (14/32) for HR+/HER2+, 64.1% (25/39) for HR-/HER2+, and 52.4% (33/63) for HR-/HER2-. The pCR rates in the low NLR and high NLR groups were 50.6% (40/79) and 54.1% (33/61), respectively (p=0.735). For HER2+ patients (n=71), the pCR rates were 51.2% (21/41) in the low NLR group and 63.3% (19/30) in the high NLR group (p=0.342). In the HR-/HER2- patients (n=63), pCR rates were 51.4% (19/37) in the low NLR group and 50.0% (13/26) in the high NLR group (p=1). On the other hand, disease-free survival (DFS) in the low NLR group was longer than in the high NLR group (p=0.07). Furthermore, DFS was significantly longer for HER2+ patients in the low NLR group than in the high NLR group (p=0.035).
Conclusions
These results indicate that a lower NLR before NAC with Abraxane may predict longer DFS than a higher NLR in HER2+ patients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.