Treatment outcomes and clinicopathologic characteristics of triple‐negative breast cancer patients who received platinum‐containing chemotherapy

Abstract

The aim of this study was to evaluate the role of platinum-containing chemotherapy for metastatic triple-negative breast cancer (TNBC) patients in terms of the response rate (RR) and progression-free survival. A second aim was to characterize the clinical behavior at the time of relapse of TNBC. We retrospectively analyzed the clinical outcomes of patients with metastatic breast cancer who received taxane-platinum chemotherapy as the first-or second-line treatment, focusing on the TN phenotype. In total, 257 patients with metastatic breast cancer received platinum-containing chemotherapy at Samsung Medical Center from 1999 to 2006. Of these patients, 106 patients with available data on estrogen (ER), progesterone (PgR) and human epidermal growth factor receptor-2 (HER2) receptor status received taxane-platinum regimen as the first-or second-line treatment. The overall RR of patients with TNBC was 39%. This rate did not differ significantly from those of patients with other phenotypes. The time to death after chemotherapy (19 vs. 50 months, p 5 0.037) and overall survival (OS) (21 vs. 56 months, p 5 0.030) differed significantly between patients with TNBC and non-TNBC. TNBC showed a unique locoregional infiltration pattern at relapse, which might reflect its aggressive clinical behavior. Despite the similar response to platinum-containing chemotherapy, patients with TNBC had a shorter OS than patients with non-TNBC. The implication of TN phenotype as poor prognostic factor is uncertain, because it needs to be defined whether poor outcome is related to the rapid growing characteristics of tumor itself or the resistance to drug therapy. Further prospective studies are warranted. ' 2008 Wiley-Liss, Inc.Key words: triple-negative breast cancer; platinum chemotherapy; BRCA1 Human breast cancer is a heterogeneous group of diseases, encompassing a number of distinct biological entities that differ in their behavior, outcome and response to therapy.1,2 DNA microarray analysis has revealed 5 subtypes of breast cancer: luminal A, luminal B, basal cell-like, human epidermal growth factor receptor-2 (HER2) positive and estrogen receptor (ER) negative, and normal-like. These subtypes have different prognoses and need different systemic treatment strategies.3,4 The basal cell-like tumors typically lack or show low expression of HER2 and ER, and exhibit a high expression level of genes characteristic of basal epithelial cells.1,4-7 These tumors might share many clinical and biologic behaviors with triple-negative breast cancers (TNBCs), which lack of expression of ER, progesterone receptor (PgR) and HER2. 5,8 However, although most basal cell-like cancers do not express ER, PgR or HER2, there is incomplete overlap between basal cell-like breast cancer and TNBC. 5,[8][9][10] The TN phenotype of breast cancer is characterized by more aggressive clinical behavior and poorer prognosis compared with the other subtypes, which likely reflect this subtype's high proliferative capacity and the lack of targeted therapies such as convent...

Predictive biomarkers for triple negative breast cancer treated with platinum-based chemotherapy

“…Most commonly used platinum agents for TNBC are cisplatin and carboplatin. [4][5][6][7][8] However, only a part of TNBC patients are extremely sensitive to platinum-based chemotherapy, while most of unselected TNBC patients get only substantial toxicities from platinum treatment. 9,10 Hence, the predictive biomarkers are urgently needed to screen out the suitable patients among the unselected groups.…”

Triple Negative Breast Cancer Treatment: Use of Platinum and Platinum Analogs

“…A retrospective study by Uhm and coworkers comparing outcome in patients with TNBC with that of patients with other BC subtypes, all treated with a taxane-platinum regimen, did not highlight a difference in response rates between these two groups [18]. A similar experience from the UK showed that patients with advanced TNBC treated with platinum-based chemotherapy had ORRs similar to those with non-TN tumors [17].…”

Neoadjuvant Systemic Therapy in Breast Cancer

“…This led to the hypothesis that triple-negative tumors may be more sensitive to DNA damaging agents, such as platinums. A retrospective analyses of patients with triple-negative breast cancer who received taxane/ platinum-based primary chemotherapy demonstrated an overall response of 39% (Uhm et al, 2009), while studies of platinum monotherapy or combinations in the neoadjuvant setting have produced pCR rates of 22%-50% (Garber et al, 2006;Chang et al, 2008).…”