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No invasive cancer left in the breast and lymph nodes when the surgeon removes the tissue after pre-surgery treatment.
Answer a few questions from a report and read the guideline statement that applies, quoted word for word with its source. Educational aids to prepare for an appointment, not advice.
Pathologic complete response (pCR) means that no invasive cancer remains in the breast and lymph nodes when the surgeon removes tissue after pre-surgery treatment, recorded as ypT0/is ypN0. It is strongly prognostic in Triple-negative breast cancer (TNBC) and HER2-positive breast cancer and is accepted for accelerated approval of neoadjuvant regimens, as in KEYNOTE-522. Trials now use it as a decision point: OptimICE-pCR (A012103) tests de-escalating therapy after pCR, while other studies escalate treatment for residual disease. The term is cited by the Oesophageal and Bladder & urothelial cancer entries, by CheckMate 816, KATHERINE, PHERGain, NICHE-2 and MATTERHORN, and by the related terms Major pathological response (MPR) and Clinical complete response (cCR).
Patients with melanoma that has spread to palpable lymph nodes should now be offered immunotherapy before rather than only after surgery: two cycles of low-dose ipilimumab with nivolumab, then surgery, with the pathology result deciding whether any more treatment is needed. Most patients respond well and are spared a year of adjuvant therapy. Serious side effects are more common than with nivolumab alone, mostly endocrine, and the approach requires close coordination between oncologists, surgeons and pathologists.
Patients fit enough for cisplatin whose bladder cancer has invaded the muscle wall should now be offered durvalumab with their pre-operative chemotherapy and for about a year after surgery, which improves the chance of cure without compromising the operation. The trial cannot say whether the adjuvant phase is necessary, or how to treat cisplatin-ineligible patients, for whom other trials are ongoing.
For colon cancer that is mismatch-repair deficient (about 10-15% of colon cancers, more in older patients), a single short course of immunotherapy before surgery is now a reasonable standard and is far more effective than chemotherapy, which has little effect in this subtype. It requires testing every colon cancer for mismatch repair at diagnosis, before surgery. Whether some patients can safely skip surgery, as in dMMR rectal cancer, is the next question.
Cercek's dostarlimab study is the clearest demonstration that immunotherapy can replace surgery in a solid tumour: patients with dMMR rectal cancer can keep their rectum and avoid the permanent effects of pelvic radiotherapy and surgery. Non-operative management after PD-1 blockade is now in guidelines for this group, and MMR testing before treatment of rectal cancer is essential. The approach applies only to the 5-10% of rectal cancers that are dMMR.
Patients with operable stage II-III lung cancer without EGFR or ALK alterations should have chemo-immunotherapy discussed before surgery rather than only afterwards. Three pre-operative cycles do not compromise the operation and improve cure rates. Whether to continue immunotherapy after surgery, as the perioperative trials do, and whether patients with pCR need any further treatment, remain open questions.
For stage II-III triple-negative breast cancer, chemotherapy plus pembrolizumab before surgery and pembrolizumab alone afterwards is now the standard approach worldwide, and the survival gain is real, not just a surrogate. It does not apply to stage I disease or to hormone-receptor-positive or HER2-positive cancers. The price is a year of immunotherapy with a meaningful chance of a permanent endocrine side effect such as hypothyroidism or adrenal insufficiency.
The third trial to show carboplatin's benefit persists beyond pathological complete response and the trial that closed the neoadjuvant PARP inhibitor route in unselected triple-negative disease; PARP inhibition survives only in germline BRCA carriers.
ctDNA clearance may refine pCR as a surrogate: a patient with residual disease but no ctDNA may not need escalation, the hypothesis behind ctDNA-guided post-neoadjuvant trials.
Shares Invasive disease-free survival (iDFS), Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer, AJCC 8th edition prognostic stage for breast cancer, Histological response to induction chemotherapy (osteosarcoma and Ewing sarcoma).
Shares Germline mutation status, pathological complete response, and disease-free survival in triple-negative breast cancer: secondary analysis of the GeparSixto randomized clinical trial, Impact of the addition of carboplatin and/or bevacizumab to neoadjuvant once-per-week paclitaxel followed by dose-dense doxorubicin and cyclophosphamide on pathologic complete response rates in stage II to III triple-negative breast cancer: CALGB 40603 (Alliance), Homologous recombination deficiency (HRD) in breast cancer, CALGB 40603 (Alliance).
Shares Tumour-infiltrating lymphocytes and prognosis in different subtypes of breast cancer: a pooled analysis of 3771 patients treated with neoadjuvant therapy, Clinical and molecular characteristics of HER2-low-positive breast cancer: pooled analysis of individual patient data from four prospective, neoadjuvant clinical trials, Germline mutation status, pathological complete response, and disease-free survival in triple-negative breast cancer: secondary analysis of the GeparSixto randomized clinical trial, Survival analysis of carboplatin added to an anthracycline/taxane-based neoadjuvant chemotherapy and HRD score as predictor of response-final results from GeparSixto.
Shares Long-Term Prognostic Risk After Neoadjuvant Chemotherapy Associated With Residual Cancer Burden and Breast Cancer Subtype, ADC for residual disease after KEYNOTE-522, ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63), Residual disease after neoadjuvant therapy in triple-negative breast cancer: the decision point.
Shares Long-term efficacy and safety of addition of carboplatin with or without veliparib to standard neoadjuvant chemotherapy in triple-negative breast cancer: 4-year follow-up data from BrighTNess, a randomized phase III trial, CALGB 40603 (Alliance), PARTNER, Sibylle Loibl.
Shares NeoTRIP (NeoTRIPaPDL1), IMpassion031, German Breast Group (GBG), Event-free / disease-free survival (EFS, DFS, iDFS, RFS).
Shares KATHERINE, Survival analysis of carboplatin added to an anthracycline/taxane-based neoadjuvant chemotherapy and HRD score as predictor of response-final results from GeparSixto, German Breast Group (GBG), KATHERINE: switching to T-DM1 when HER2-positive breast cancer survives pre-surgery treatment.
Shares Major pathological response (MPR), Pre-surgery platform trials that test combinations on pathological response in months, Use pre-surgery immunotherapy windows as the field's biomarker engine, NADINA: two doses of ipilimumab plus nivolumab before surgery beat a year of nivolumab after surgery in stage III melanoma.