Abstract 29P
Background
RCB, CPS and CPS-EG score are prognostic models for pts who received NAC. For CPS and CPS-EG models limited data exist beyond 5y. We evaluated the long-term performance of these models in our ER+/HER2- BC pts receiving NAC, and the impact of incorporating Ki67 drop and EET on them.
Methods
Records of pts with lumB-like BC (Ki67≥20%) receiving NAC from 2008 to 2015 at our Hospital. Ki67 drop: Ki67% at surgery minus Ki67% at initial biopsy (Ki67-pre). Uni and multivariate Cox models for Distant Disease-Free Survival (DDFS) and Overall Survival (OS), concordance indexes (c-index). 5y Landmark analyses to assess the impact of ETT.
Results
Population: N = 202; median (M) age 47y (24-78); PgR:43%/20-95, Ki67-pre M/range 40/ 20-95; Histologic Grade (%) 2/3: 57/41; stage 2/3 (%): 62/38; pCR: 12%. Follow-up (M): 9.6 y. EET prescribed in 45% of pts alive without recurrence at 5y. For all pts, 10 y-DDFS (%, 95% IC) was 64% (57-72). For pts with/without pCR, 10 y-DDFS were 87% (75-100%) and 61% (53-70%), respectively (p=0.03). 10 y-DDFS and OS according to RCB, CPS and CPS+EG models are shown in the table. In DDFS, the c-index for RCB, CPS and CPS+EG were 0.70, 0.72 and 0.66, respectively for all pts and 0.69, 0.70 and 0.66, for the non-pCR cohort. Ki67 drop ≥ 20% was observed in 59% of non-pCR pts. The addition of Ki67-drop categories did not enhance the c-index of any model. EET prescription did not improve DDFS but was associated to a higher 5y OS: 89% (95% CI 81-98%) vs 68 % (95% CI 58- 81%), p < 0.01. Table: 29P
| Prognostic model | N | DDFS HR IC 95% | p value | OS HR IC 95% | p value |
| RCB | |||||
| 0 | 26 (17%) | ||||
| 1 | 16 (11%) | 1.1 (0.19-6.6) | 0.91 | 0.62 (0.06-6) | 0.68 |
| 2 | 74 (48%) | 1.7 (0.48-5.77) | 0.43 | 1.37 (0.38-4.95) | 0.63 |
| 3 | 36 (24%) | 5.1 (1.48-17.4) | < 0.01 | 4.8 (1.36-16.4) | 0.01 |
| CPS | |||||
| 0 | 43 (22%) | ||||
| 1 | 43 (22%) | 3.4 (1.1-11) | 0.03 | ||
| 2 | 71 (36%) | 3.9 (1.33-11.2) | 0.01 | 2.12 (1.01-4.46) | 0.05 |
| 3 | 35 (17%) | 9.5 (3.25-27.7) | < 0.01 | 5.9 (2.88-12.4) | < 0.01 |
| 4 | 6 (3%) | 55 (14.87-206.7) | < 0.01 | 22.6 (8.09-63.4) | < 0.01 |
| CPS+EG | |||||
| 0 | 11 (8%) | ||||
| 1 | 28 (20%) | 0.2 (0.02-2.1) | 0.18 | ||
| 2 | 46 (33%) | 1.2 (0.26-5.5) | 0.81 | ||
| 3 | 35 (25%) | 2.6 (0.59-11.4) | 0.21 | 3.63 (1.59-8.3) | < 0.01 |
| 4 | 19 (13%) | 3.5 (0.75-16) | 0.11 | 4.8 (1.95-11.8) | < 0.01 |
| 5 | 2 (1%) | 44.3 (5.7-343.4) | < 0.01 | 28.8 (6.08-136.3) | < 0.01 |
Conclusions
In our luminal B-like BC pts, both CPS and CPS-EG models showed comparable long-term prognostic value, surpassing RCB. EET correlated with improved OS. Integrating Ki67 drop categories didn't enhance model performance, though limited numbers prevent definitive conclusions.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
L. Sanz Gomez: Financial Interests, Personal and Institutional, Invited Speaker: Pfizer, AstraZeneca, Daiichi Sankyo. E. Zamora Adelantado: Financial Interests, Personal, Invited Speaker, Review session for medical oncologists: Eisai, Lilly; Financial Interests, Personal, Invited Speaker, Manegement of iCDK toxicities to oncologist nurses: Novartis; Other, Registration to ESMO Congress 2022 (virtual): Novartis; Other, Registration to: Eisai; Other, Virtual registration to ASCO Congress 2023: Novartis; Other, Registration to SEOM Congress 2023: Lilly; Other, Registration to ESMO Breast Cancer Congress 2023: MSD; Other, Registration to ESMO Congress (virtual): Roche. C. Saura Manich: Financial Interests, Personal, Advisory Board: AstraZeneca, Daiichi Sankyo, Eisai, Exact Sciences, Exeter Pharma, F. Hoffmann - La Roche Ltd., Gilead, Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Philips, Pierre Fabre, PintPharma, Puma, Roche Farma, Sanofi Avenits, Seagen, Zymeworks, Pharmalex Spain SLU; Financial Interests, Personal, Expert Testimony: Boehringer Ingelheim, Bristol Meyers Squibb, Genentech, Innoup, Millenium; Financial Interests, Personal, Other, SC: Byondis B.V., GSK, Macrogenics, Menarini, Merus, Synthon Biopharpaceuticals; Financial Interests, Institutional, Research Grant: AstraZeneca, Bayer Pharma, Boehringer Ingelheim, Bristol Myers Squibb (BMS), Cytomx Therapeutics, Daiichi Sankyo, Eli Lilly and Company, F. Hoffmann-La Roche Ltd., Genentech, GSK, Immunomedics, Innoup Farma, Macrogenics, Menarini Ricerche, Merus, Novartis, Pfizer, Puma, Roche, Sanofi-Aventis, Seattle Genetics; Financial Interests, Institutional, Invited Speaker: Byondis B.V.; Non-Financial Interests, Member: Spanish Society of Medical Oncology (SEOM), American Society for Clinical Oncology (ASCO), Geicam (Spanish Breast Cancer Research Group), European Society for Medical Oncology (ESMO), Sinology Society of the Official College of Physicians of Barcelona (COMB); Non-Financial Interests, Member, Junta Directiva y Comité Científico: SOLTI group (Academic research group in breast cancer). V. Peg Cámara: Financial Interests, Personal, Speaker’s Bureau: Sysmex; Financial Interests, Personal, Advisory Board: Sysmex, Roche, AstraZeneca, Exact Sciences, Bayer, Daiichi Sankyo; Financial Interests, Personal, Other, Travel grant: Sysmex; Financial Interests, Personal, Invited Speaker: Roche, MSD, AstraZeneca, Exact Sciences, Daiichi Sankyo; Financial Interests, Personal, Advisory Role: MSD. R. Dienstmann: Financial Interests, Personal, Invited Speaker: Amgen, AstraZeneca, Boehringer Ingelheim, Ipsen, Libbs, Lilly, Merck Sharp & Dohme, Roche, Sanofi, Servier, GSK, Takeda, Janssen, Gilead, Bristol Myers Squibb; Financial Interests, Personal, Advisory Board: Roche, Foundation Medicine; Financial Interests, Personal, Full or part-time Employment, Oncoclínicas is a private healthcare provider in Brazil. I work part time as Medical Director of the Precision Medicine and Big Data Initiative. We develop molecular tests (pathology and genomics) that are offered to patients treated in the organisation as part of support programs sponsored by pharmaceutical companies and I coordinate research activities with real-world clinico-genomics cohorts: Oncoclínicas; Financial Interests, Personal, Stocks/Shares: Trialing; Financial Interests, Personal, Research Grant: Merck; Financial Interests, Institutional, Research Grant: Novartis, AstraZeneca, Daiichi Sankyo, GSK. M. Bellet Ezquerra: Financial Interests, Personal, Advisory Board: Pfizer, Novartis, Lilly, Stemline-Menarini; Other, Speaker’s Bureau and Travel Expenses: Pfizer; Other, Speaker's Bureau: Novartis, Lilly. All other authors have declared no conflicts of interest.