Authors’ reply to Reddy

Abstract

We sincerely appreciate the thoughtful comments made by Reddy[1] in his correspondence regarding our study, “The impact of pathological complete response on survival in patients with breast cancer and occurrence in different intrinsic subtypes: A retrospective observational study.”[2] We are pleased to address the points raised in the letter. Ghosh and Ganguly[3] aptly emphasized the multifaceted nature of the pathological complete response (pCR) as a surrogate marker for survival outcomes in neoadjuvant clinical trials. We concur that pCR may not serve as an absolute predictor of long-term survival, as evidenced by the contrasting findings in previous studies,[4] including those highlighted by Conforti et al.[5] and Cortazar et al.[6] Our study sought to contribute to this ongoing discourse by evaluating the correlation of pCR with outcomes within the context of different intrinsic subtypes of breast cancer while evaluating our own practice at the same time. Ghosh and Ganguly[3] pointed out the potential influence of differing neoadjuvant chemotherapy regimens on the attainment of pCR. As rightly pointed out by Reddy,[1] including patients who received more than or at least six cycles of neoadjuvant chemotherapy would have been more prudent, and we intend to re-look at our data from this new perspective. This could have been the reason behind the modest pCR rate of 16.7% achieved in our study.[2] Additionally, the absence of data regarding adjuvant treatment and subsequent lines of therapy is noted, and this could certainly have played a role in influencing survival outcomes. However, we would like to point out that the compliance of our patients to anti-HER2 therapy in the adjuvant setting was better than that observed in the neoadjuvant setting. We are gratified by the inclusion of insights from the CREATE-X[7] and KATHERINE trials,[8] which underscore the evolving landscape of pCR’s predictive potential. The results from these trials support the notion that pCR can guide treatment modifications and lead to improved outcomes. Results from these trials are now being incorporated regularly in clinical practice; this study was an eye-opener for us, and it will hopefully motivate others as well. In conclusion, we concur with Ghosh and Ganguly’s[3] assertion that while the role of pCR as a survival marker in clinical trials remains debated, it does hold significant prognostic value for individuals.[9] We extend our gratitude to them for enriching the discourse surrounding our study and the broader understanding of the implications of achieving pCR and also to Reddy for his insights.[1] Further data from real-world settings will undoubtedly shed more light on the intricate interplay between pCR, treatment strategies, and patient outcomes. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.