The survival benefit of neoadjuvant chemotherapy and pCR among patients with advanced stage triple negative breast cancer

Abstract

Triple negative breast cancer (TNBC) is an aggressive subtype that accounts for 15-20% of cases, with a higher incidence of relapse/death. Even with adjuvant chemotherapy, the 5 year distant metastasis-free survival rate remains low. A total of 452 tumor registry patients with TNBC and no evidence of metastatic disease were identified over the period of 1996-2011. The median age and follow-up time were 51 (range=21-88) and 3.9 (range=0.14-14) years. Approximately 75% of patients with stage III disease received neoadjuvant chemotherapy (NACT) compared with 47% for stage II. Patients with stage I disease predominantly received adjuvant chemotherapy (ACT). Among those who underwent NACT (n=202), 33% had a pathological complete response (pCR). Overall (OS) and disease-free (DFS) survival were significantly longer among patients achieving pCR (versus residual disease) following NACT (OS: all patients P<0.0001, stage II P<0.0001, stage III P=0.0062; DFS: all patients P<0.0001, stage II P=0.0011, stage III P=0.015). ACT was not associated with improved OS or DFS for stage III disease. Adjustment for age, chemotherapy, health insurance type, lymphovascular invasion, race, radiation, and surgery did not alter our results. These findings suggest that pCR following NACT is associated with improved survival among patients with TNBC, independent of diagnostic stage.

Validity and Reliability of the Decision Regret Scale in Cancer Patients Receiving Adjuvant Chemotherapy

“…As regards external validity, convergent validity was acceptable and a pattern of significant correlations with health outcomes was observed in the expected direction. This is particularly relevant, since adjuvant chemotherapy is the treatment of choice after surgery for certain locally advanced cancers, such as breast and colon cancer, and treatment tends to have immediate, negative repercussions for patients' physical status, symptomatology, and global QoL 29 , although their adverse effects are usually temporary 29 . Our results indicate that the patients most likely to regret treatment are those with worse QoL, including physical status, presence of symptoms, and greater psychological distress.…”

Present and changing trends in surgical modalities and neoadjuvant chemotherapy administration for female breast cancer in Beijing, China: A 10‐year (2006–2015) retrospective hospitalization summary report‐based study

“…Complications and side effects are also major issues . Large multi‐center studies conducted in Australia, Asia, Europe, and the United States (US) have shown that NACT could achieve pathological complete response in HR−/HER2+ and triple negative tumors, which serves as a strong prognostic factor for longer overall survival …”

“…27 Large multi-center studies conducted in Australia, Asia, Europe, and the United States (US) have shown that NACT could achieve pathological complete response in HR−/HER2+ and triple negative tumors, which serves as a strong prognostic factor for longer overall survival. 21,[28][29][30] This study was conducted to describe the utility of surgical modalities in different age and histologic groups and to determine the changing trends between 2006 and 2015.…”

Neoadjuvant Chemotherapy in Triple Negative Breast Cancer: Correlation between Androgen Receptor Expression and Pathological Response

“…The elegant progress of target therapies in HR+/ Her-2+ BC forced the investigators to recognize target therapies in TNBC. The introduction of AR evaluation in these subgroups of patients is really a huge step forward as it may help to determine the disease behavior (Biswas et al, 2017).…”