Residual cancer burden (RCB)
A score for how much cancer is left after pre-surgery treatment, from 0 (none) to III (a lot).
MD Anderson index combining tumour bed size, cellularity, and nodal involvement. RCB-II/III after neoadjuvant therapy predicts high relapse risk and defines populations for escalation trials (e.g., ctDNA-guided or ADC-based post-neoadjuvant therapy).
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.
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.
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.
Pages like this
not linked directly; found by shared links- TrialKEYNOTE-522
Shares ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63), TROPION-Breast03, ADC for residual disease after KEYNOTE-522, Pre-surgery platform trials that test combinations on pathological response in months.
- PersonZhi-Ming Shao
Shares KATHERINE: switching to T-DM1 when HER2-positive breast cancer survives pre-surgery treatment, OlympiA: a year of olaparib after surgery for BRCA-mutated, high-risk early breast cancer, Triple-negative breast cancer (TNBC).
- PersonSibylle Loibl
Shares KATHERINE: switching to T-DM1 when HER2-positive breast cancer survives pre-surgery treatment, OlympiA: a year of olaparib after surgery for BRCA-mutated, high-risk early breast cancer, Triple-negative breast cancer (TNBC).
- TermPathologic complete response (pCR)
Shares ASCENT-05 / OptimICE-RD (AFT-65, GBG 119, NSABP B-63), Laura J. Esserman, ADC for residual disease after KEYNOTE-522, Pre-surgery platform trials that test combinations on pathological response in months.
- PersonCharles E. Geyer Jr.
Shares KATHERINE: switching to T-DM1 when HER2-positive breast cancer survives pre-surgery treatment, OlympiA: a year of olaparib after surgery for BRCA-mutated, high-risk early breast cancer, Triple-negative breast cancer (TNBC).
- PersonMariana Chavez-MacGregor
Shares MD Anderson Cancer Center, Triple-negative breast cancer (TNBC).
- PersonCarsten Denkert
Shares KEYNOTE-522: adding pembrolizumab before and after surgery in early triple-negative breast cancer, Triple-negative breast cancer (TNBC).
- PersonDebu Tripathy
Shares MD Anderson Cancer Center, Triple-negative breast cancer (TNBC).