Survivin As a Predictive Biomarker of Complete Pathologic Response to Neoadjuvant Chemotherapy in Patients With Stage II and Stage III Breast Cancer

Introduction: Predictive biomarkers of response to neoadjuvant chemotherapy in patients with breast cancer are needed to better characterize tumors and enable more tailored therapies. Methods: The expression levels of survivin, BCL-2, cyclin D1, ETS1, and PDEF in tumor samples obtained in the diagnostic biopsies of patients undergoing neoadjuvant chemotherapy for stage II and stage III disease were evaluated by immunohistochemistry (IHC). The mean expression score (range, 0-15) obtained by 3 different pathologists was used for analysis and correlated with complete pathologic response (pCR) and survival by standard univariate and multivariate methods. Results: Forty-five female patients were included in this study and received preoperative standard anthracycline/taxane-based chemotherapy. The median age at diagnosis was 49 years (range, 25-70 years). Three patients (7.1%) achieved pCR. The mean expression score of survivin in the diagnostic biopsies was significantly higher (P = .01) in patients with pCR (9.3) than in those without (3.4). There was no significant association with pCR for the other biologic markers analyzed nor was there correlation with prognosis. Survivin levels were not associated with age, tumor grade, clinical stage, or receptor status. Conclusion: High expression levels of survivin in the primary tumor may be used as a potential predictive biomarker of pCR to neoadjuvant chemotherapy in patients with stage II and stage III breast cancer.