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A pathology score for how much cancer remains in the breast and lymph nodes after pre-surgery treatment, from 0 (none) to III (a large amount), combining tumour bed size, cellularity and nodal involvement. RCB-II or III after neoadjuvant therapy predicts a high risk of relapse and defines who enters escalation trials.
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.
Residual cancer burden (RCB) is a score for how much cancer is left after pre-surgery treatment, running from 0 for none to III for a large amount. The index, developed at MD Anderson Cancer Center, combines tumour bed size, cellularity and nodal involvement, and an RCB-II or RCB-III result after neoadjuvant therapy predicts a high risk of relapse and defines populations for escalation trials, including ctDNA-guided and ADC-based post-neoadjuvant therapy. In this corpus it is attached to Triple-negative breast cancer (TNBC) and is used by the ASCENT-05 / OptimICE-RD and TROPION-Breast03 trials, by Laura J. Esserman, and by an idea on an ADC for residual disease after KEYNOTE-522. The KEYNOTE-522, OlympiA and KATHERINE papers also refer to it.
ctDNA and RCB measure different things and both should stratify post-neoadjuvant TNBC trials; an RCB-II patient with negative ctDNA has an 87% three-year event-free survival.
The first prospective test of acting on ctDNA in triple-negative disease, and a negative one: with a quarterly, single-mutation assay the window between detectable DNA and visible metastasis was too short to intervene. Later designs use tumour-informed assays, earlier sampling and drugs with more single-agent activity.
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 external validation the 2017 paper asked for; it is why residual cancer burden is reported in UK and European pathology and used as a trial entry criterion rather than an MD Anderson curiosity.
Everyone with HER2-negative early breast cancer that meets high-risk criteria should be offered germline BRCA testing, because a positive result now changes treatment: a year of olaparib after chemotherapy reduces relapse and death. It does not apply to low-risk tumours, HER2-positive disease, or somatic-only BRCA mutations.
The proof that a blood test can split residual-disease patients into those likely to relapse and those likely cured, the premise of the ctDNA-guided adjuvant idea; no completed trial has yet acted on the result.
HER2-positive breast cancer is now routinely treated before surgery so that the pathology result can guide what comes after: patients with no residual cancer continue trastuzumab (with or without pertuzumab), while those with residual disease switch to T-DM1. This model of using the tumour's response as a test has since been copied in triple-negative and other cancers.
Established that residual disease after neoadjuvant chemotherapy is a treatable state, the principle behind OlympiA and the post-neoadjuvant antibody-drug conjugate trials; capecitabine remains the option for residual triple-negative disease without a BRCA variant in ESMO, NCCN and UK practice.
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 Residual cancer burden after neoadjuvant chemotherapy and long-term survival outcomes in breast cancer: a multicentre pooled analysis of 5161 patients, A-BRAVE, BRE12-158 (Hoosier Oncology Group), SWOG S1418 / NRG BR006.
Shares BRE12-158 (Hoosier Oncology Group), c-TRAK TN, Residual disease after neoadjuvant therapy in triple-negative breast cancer: the decision point, Early triple-negative breast cancer.
Shares Homologous recombination deficiency (HRD) in breast cancer, CALGB 40603 (Alliance), KEYNOTE-522, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem.
Shares A-BRAVE, SWOG S1418 / NRG BR006, KEYNOTE-522, Early triple-negative breast cancer.
Shares NeoPACT, KEYNOTE-522, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Early triple-negative breast cancer.
Shares Invasive disease-free survival (iDFS), Residual disease after neoadjuvant therapy in triple-negative breast cancer: the decision point, OlympiA: a year of olaparib after surgery for BRCA-mutated, high-risk early breast cancer, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem.
Shares CREATE-X, Residual disease after neoadjuvant therapy in triple-negative breast cancer: the decision point, Early triple-negative breast cancer, Triple-negative breast cancer (TNBC).