Abstract PO5-26-04: The value of skin involvement in achieving of pCR in patients with locally advanced breast cancer
Authors: Amosova Viktory , Petrovskiy Alexander , Trofimova Oxana , Frolova Mona , Rumyantsev Alexey 
Published: May 2024

Objective: The management of patients with locally advanced breast cancer (LABC) with skin involvement (edema or thickening) continues to be one of the most controversial topics in mammology. The most recommended conventional treatment strategies include systemic therapy (chemotherapy/hormone therapy/biological agents) followed by local therapy (surgery and/or radiation therapy). However, approximately 1/3 of patients with locally advanced breast cancer are “resistant” to neoadjuvant chemotherapy (which is manifested by the persistence of skin involvement/edema/thickening). In this study, we aimed to identify the relationship between skin involvement and clinicopathological features of LABC patients. In particular, we sought to develop the algorithm for skin involvement measurement and examine the impact of skin involvement on the rate of pCR.

Materials and methods: We performed a retrospective analysis of 182 patients diagnosed with LABC from 2010 to 2018 at N.N. Blokhin National Cancer Research Center. All patients were treated with neoadjuvant hormone- or chemotherapy and were considered as borderline for surgical resection because of partial skin edema. Ninety one women received surgery with consecutive radiotherapy (first group) and 50 women (second group) received radiotherapy (total dose 50 Gy) with consecutive surgery after systemic treatment. We developed the algorithm for skin involvement measurement, using a series of formulas. We further interrogated the impact of skin involvement on the rate of breast and lymph node pathological response in every group.

Results: The median percentage of skin edema before systemic therapy was 76.3% in the first group and 70.1% in the second group. The median percentage of skin edema after systemic therapy was 62.3% in the first group and 69.1% in the second group. There wasn`t a statistically significant difference between the two groups (р=0,675 and р = 0,286, respectively).

Breast pCR was seen in 19,7% (n=18) of the first group patients and partial response was seen in 72.6% (n=66). Breast pCR was seen in 30% (n=15) of the second group patients and partial response was seen in 70% (n=35). Results showed no significant differences between groups, р=0,342 and р = 0,12, respectively. Nodal pCR was reported in 23,9% (n=16) and partial response in 50,8% (n=34) of the 67 node-positive patients. Nodal pCR was reported in 31,6% (n=12) and partial response in 65,8% (n=29) of the 38 node-positive patients of the second group. There was no statistical difference in the groups, p &gt;0,05.

Conclusion: Increasing attention has been paid to LABC patients due to the clinical commonness and the complexity of treatment. Our study showed that LABC patients with incomplete clinical response to neoadjuvant systemic therapy can achieve pCR or partial response of tumor despite partial skin edema. In this study we developed the algorithm for skin involvement measurement. We hope that knowledge about volume of skin involvement revealed by this study might shed light on individualized therapies for these patients. In future, it allows to evaluate criteria of tumor resectability to improve patient selection. Therefore, prospective randomized trials are needed to improve optimization of the local treatment.

Citation Format: Viktory Amosova, Alexander Petrovskiy, Oxana Trofimova, Mona Frolova, Alexey Rumyantsev. The value of skin involvement in achieving of pCR in patients with locally advanced breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-26-04.