Fig. 5: Retrospective analysis of menstrual cycle-dependent sensitivity to NAC in patients with BC.
From: The oestrous cycle stage affects mammary tumour sensitivity to chemotherapy
a, Flowchart of case-selection processes for the HR+HER2− BC cohort (cohort 1) and TNBC cohort (cohort2 ), showing every selection step. b,e, Evaluation of BC treatment response to NAC initiated during the progesterone-low (top) and progesterone-high phase (bottom) in patients with HR+HER2− (b) and TNBC (e), based on Response Evaluation Criteria in Solid Tumours 1.1111 criteria. c,f, Change in size of target lesion post treatment compared with pretreatment, as a percentage, in patients with HR+HER2− BC (c) and TNBC (f). Blue and red represent progesterone-low and -high conditions, respectively. Solid bars indicate patients from the Antoni van Leeuwenhoek Hospital-Netherlands Cancer Institute (AvL-NKI), striped bars indicate patients from the Dutch Breast Cancer Research Group DIRECT study, with data collected at the Clinical Research centre of Leiden University Medical Center (LUMC). Tumour (T), lymph node (N), metastases (M) staging of individual patients is indicated below bars. Dashed lines indicate −30% and +20%, which represent the thresholds for response and progression in HR+HER2− tumours (c); −30% indicates minimal reduction in tumour size for a partial response classification in TNBC (f) based on Response Evaluation Criteria in Solid Tumours 1.1111 guidelines. d,g, Change in primary tumour size following NAC relative to tumour size before treatment, as a percentage in patients with HR+HER2− BC (d) and TNBC (g). HR+HER2−: n = 17 (progesterone-low) and n = 13 (progesterone-high) at first NAC treatment; TNBC: n = 17 (progesterone-low) and n = 8 (progesterone-high) at first NAC treatment. Data shown as violin plots; thicker solid lines represent median, thinner solid lines indicate the 25th and 75th percentiles and dots represent individual patients. Statistical analysis was performed using two-sided Wilcoxon–Mann–Whitney testing. *P < 0.05, **P < 0.01. Further details on statistical analysis are provided in Supplementary File 1.
