Exceptional Responders in Breast Cancer

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Moderator Adam M. Brufsky, MD, PhD, discusses a 30 year-old patient with BRCA-negative metastatic triple-negative breast cancer who received 4 cycles of cyclophosphamide and doxorubicin followed by weekly paclitaxel. After 12 cycles of paclitaxel, the patient experienced a complete response. After a year of treatment, therapy was stopped, with no evidence of disease. Following 6 months off therapy, the patients asked for a bilateral mastectomy.

In this scenario, the panelists would not recommend a mastectomy; however, they would not advise against it. In general, the consensus of the panel is that a lumpectomy with logo-regional management would be the ideal treatment approach.

Mounting evidence suggests that long-term outcomes are superior if treatment is not stopped, notes Hope S. Rugo, MD. However, in many situations, patients will request a break from chemotherapy. The response experienced by this patient is very unusual, Rugo notes, marking her as an 'exceptional responder.'

Host genetics and immune response could be the key to exceptional responders, notes Brufsky. Research is beginning to focus on these unique patients who respond well to therapy. Traditionally, the genetics of the tumor have been the emphasis; however, this program focuses on the patient.

The NCI established the exceptional responders initiative to focus on understanding why some patients have better responses to therapy. Studying these patients could help unlock new treatment strategies. Patients who experience an exceptional response