Originally published as JCO Early Release 10.1200/JCO.2009.23.8022 on August 10 2009

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Breast Cancer Subtypes and Response to Docetaxel in Node-Positive Breast Cancer: Use of an Immunohistochemical Definition in the BCIRG 001 Trial

Departments of Medicine and Oncology, Jewish General Hospital, Montreal, Quebec, Canada

To the Editor:

The article by Hugh et al¹ presents a useful classification of node-positive breast cancer to indicate survival and best use of chemotherapy with docetaxel, doxorubicin, and cyclophosphamide versus fluorouracil, doxorubicin, and cyclophosphamide. However, in the luminal B group—in which, compared with the luminal A group, survival was midway between the triple-negative and human epidermal growth factor receptor 2 (HER2) –positive groups—22% of the patients were HER2 positive. Because we routinely treat all HER2-positive patients with Herceptin (trastuzumab; Genentech, South San Francisco, CA) and chemotherapy, it would be of great interest to see disease-free and overall survival for the luminal B group without including the HER2-positive patients. The major difference between the luminal A and B groups without HER2 considered would be the Ki67-1 index, which was high in the majority of patients in the luminal B group and low in all patients in the luminal A group. Examining Figure 4 in the article, one has the impression that use of docetaxel, doxorubicin, and cyclophosphamide rendered the disease-free survival of the luminal B group without HER2-positive patients almost equivalent to that of the luminal A group. Thus, the major benefit of the luminal B subclassification may be in selecting patients who are most apt to benefit from taxane-containing chemotherapy, which would then render their prognosis similar to that of the luminal A group.

AUTHOR'S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

REFERENCE

1. Hugh J, Hanson J, Cheang MC, et al: Breast cancer subtypes and response to docetaxel in node-positive breast cancer: Use of an immunohistochemical definition in the BCIRG 001 trial. J Clin Oncol 27:1168–1176, 2009.[Abstract/Free Full Text]

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				J. Hugh, J. Hanson, M. Cheang, T. Nielsen, C. Perou, C. Dumontet, J. Reed, M. Krajewska, I. Treilleux, M. Rupin, et al. Reply to L.C. Panasci J. Clin. Oncol., September 10, 2009; 27(26): e112 - e113. [Full Text] [PDF]

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