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Pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) for breast cancer predicts the risk of recurrence and increasingly may indicate the need for additional therapy postoperatively. We identified non-metastatic breast cancer patients receiving NACT during 2013–2017. Patients’ and disease characteristics, rates of pCR (ypT0-is ypN0), toxicities, dose delays and reductions, and survival outcomes were recorded. 789 patients had median age of 50 years. 67.8% had stage II disease, 71.1% had grade 3 , and 91.8% had ductal histopathology. 32.8% had estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, 25.5% had triple-negative (TN), and 38.0% HER2-positive disease. 6.8% received platinum. 48.2% of the HER2-positive patients received trastuzumab and pertuzumab and 51.8% received trastuzumab. Overall pCR rate was 33.5% and differed according to disease subtype, receptor status, grade, histology, and early discontinuation, but not according to age, dose reductions/delays, or year of treatment. The addition of pertuzumab to trastuzumab marginally improved the pCR rates. Survival outcomes were better following pCR. In our analysis, pCR rates are consistent with the published data. Even with contemporary therapies, many patients have residual disease following NACT, suggesting a significant risk of recurrence, and may benefit from additional postoperative systemic therapy.

Purpose Leptomeningeal disease (LMD) is an uncommon complication of advanced breast cancer. The prognosis is poor, and although radiotherapy (RT), systemic and intra-thecal (IT) chemotherapy are accepted treatment modalities, efficacy data are limited. This study was designed to evaluate potential predictors of survival in this patient group. Methods Breast cancer patients with LMD diagnosed by MRI in a 10-year period (2004–2014) were identified from electronic patient records. PFS and OS estimates were calculated using Kaplan-Meier method, with planned sub-group analysis by treatment modality. Cox regression was employed to identify significant prognostic variables. Results We identified 182 eligible patients; all female, median age at LMD diagnosis 52.5 years (range 23–80). Ninety patients (49.5%) were ER positive/HER2 negative; 48 (26.4%) were HER2 positive, and 27 (14.8%) were triple negative. HER2 status was unknown in 17 (9.3%). Initial management of LMD was most commonly whole or partial brain RT in 62 (34.1%), systemic therapy in 45 (24.7%) or supportive care alone in 37 (20.3%). Fourteen patients (7.7%) underwent IT chemotherapy, of whom two also received IT trastuzumab. From diagnosis of LMD, the median PFS was 3.9 months (95%CI 3.2–5.0) and median OS was 5.4 months (95%CI 4.2–6.6). Patients treated with systemic therapy had the longest OS (median 8.8 months, 95%CI 5.5–11.1), compared to RT; 6.1 months (95%CI 4.2–7.9 months), IT therapy; 2.9 months (95%CI 1.2–5.8) and supportive care; 1.7 months (95%CI 0.9–3.0). On multivariable analysis, triple negative histology, concomitant brain metastases, and LMD involving both the brain and spinal cord were associated with poor OS. Conclusions Breast cancer patients with triple negative LMD, concomitant brain metastases or LMD affecting both the spine and brain have the poorest prognosis. Clinical trials to identify more effective treatments for these patients are urgently needed.

The systemic adjuvant treatment of early breast cancer (EBC) has benefited from a multifaceted approach. Generic cytotoxic approaches, as well as a more targeted approach to the estrogen receptor or HER2 receptor are now established standards of care. Decades of innovative trials exploring bisphosphonates in breast cancer prevention and EBC for bone protection, as well as large prospective randomized trials have resulted in an overwhelming case for benefit in post menopausal women. Therapies such as everolimus and the PARP inhibitors, established in the secondary breast cancer setting, are being explored in the adjuvant setting for utility. Similarly, observational and retrospective studies have demonstrated a strong reduction in breast cancer risk with the use of metformin and aspirin, and hence large prospective randomized trials are underway.