Certain pathologic and biological features of a breast carcinoma may affect the likelihood of a response to neoadjuvant chemotherapy.
|
Parameter |
Finding |
Response |
|
differentiation |
well-differentiated |
consistently unfavorable |
|
|
high nuclear grade |
consistently favorable |
|
|
high mitotic index |
may be favorable |
|
markers |
estrogen receptor negative |
usually favorable |
|
|
estrogen receptor positive |
usually unfavorable |
|
|
mitosin staining |
usually favorable |
|
|
high treatment-induced apoptosis |
may be favorable |
|
|
decrease in bcl-2 after treatment |
usually favorable |
|
|
HER-2/neu overexpression |
usually unfavorable |
|
|
p53 mutations |
usually unfavorable |
|
|
low Bax |
usually unfavorable |
where:
• The association with estrogen receptor status may reflect tumor differentiation.
• High nuclear grade and a high mitotic index are associated with poorly differentiated tumors.
• Bcl-2 is a negative regulator of apoptosis, so a decrease in bcl-2 is associated with increased apoptosis. I am not sure if an increased bcl-2 after treatment is associated with an unfavorable response.
• A low Bax is associated with decreased apoptosis. I am not sure if a high Bax is associated with a favorable response.
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
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