Triple negative breast cancer: Clinical characteristics in the different histological subtypes

Dreyer, G.; Vandorpe, Thijs; Smeets, Ann; Forceville, Kathleen; Brouwers, Barbara; Neven, Patrick; Janssens, Hilde; Deraedt, Karen; Moerman, Philippe; Calster, Ben Van; Christiaens, Marie-Rose; Paridaens, Robert; Wildiers, Hans

doi:10.1016/j.breast.2013.01.009

Cited by 48 publications

(51 citation statements)

References 24 publications

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“…Matsuo et al reported that in patients with AAC, older age and postmenopausal status were observed more frequently than in those with IDC [9]. The study of Tanaka et al and Dreyer et al also confirmed that the patients with AAC were older [10, 11]. However, no significant difference with regard to menopausal status was observed between the two groups [10].…”

Section: Discussionmentioning

confidence: 98%

“…Tanaka et al also reported the proportion of AAC with LN metastasis and lymphatic invasion were significantly lower in the AAC patients than in the IDC patients [10]. In contrast, Dreyer et al showed 7 out of 14 apocrine breast carcinomas with positive lymph node status [11] and Choi et al reported the rage of lymph node metastasis was highest in the molecular apocrine type, although not statistically significant [21]. The inconsistence might be due to the heterogeneity of cohort since the study only involved very small number of patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, they only involved 12 patients in their study. Tanaka et al found lower frequency of axillary nodal involvement in AAC compared to IDC [10]; while Dreyer et al showed 7 out of 14 apocrine breast carcinomas with positive lymph node status [11]. With respect to prognosis, some of these studies indicated better prognosis in AAC than IDC patients [12–15]; while in some other studies, no significant difference or even poor survival outcome of AAC was detected compared to non-AAC [7, 10, 16–20].…”

Section: Introductionmentioning

confidence: 99%

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Dose invasive apocrine adenocarcinoma has worse prognosis than invasive ductal carcinoma of breast: evidence from SEER database

Zhang

Chen

et al. 2017

Oncotarget

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BackgroundInvasive apocrine adenocarcinoma (AAC) of breast is a rare histopathological subtype of breast carcinomas. We aim to investigate the different characteristics and prognostic outcomes between AAC and invasive ductal carcinoma (IDC) of breast cancer.RESULTSAAC patients presented with older ages, more aggressive behaviors, lower ER and PR proportions, higher HER2 amplification rates and less application of breast-conserving therapy and adjuvant chemotherapy compared to IDC patients. Long-term OS and DSS were both worse in ACC patients (p = 0.006, p = 0.012 respectively) than in IDC patients by Kaplan-Meier analysis. However, no significant difference was detected in DSS (p = 0.181) and OS (p = 0.116) between the matched two histological subtypes. Further subgroup analysis indicated that AJCC stage, ER status, PR status and HER2 status may be principal confounders for AAC prognosis.Materials and MethodsWith accession to the Surveillance, Epidemiology and End Result (SEER) database, a total of 260,596 patients met the eligibility criteria. Clinicopathological characteristics were compared between groups using Chi-square test. Univariate and multivariate analyses were applied to evaluate the overall survival (OS) and disease-specific survival (DSS). Subgroup analyses summarized the hazard ratio (HR) of AAC versus IDC using a forest plot.ConclusionsAAC had unique clinicopathological characteristics and it tended to be a more aggressive type than IDC. However, the worse prognosis was diminished after matching for demographic and clinicopathological factors. Deeper insights into AAC are in need to contribute to individualized and tailored therapy, which thereby may improve clinical management and outcomes.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dose invasive apocrine adenocarcinoma has worse prognosis than invasive ductal carcinoma of breast: evidence from SEER database

Zhang

Chen

et al. 2017

Oncotarget

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“…The concern about prognostic differences in relation to biomarker expression is not just theoretic; there are recognized clinical patterns associated with predictive biomarkers in a number of cancers, such as EGFR mutations and the EML4-ALK fusion protein in nonsmall-cell lung cancer, 24,25 human epidermal growth factor receptor-positive and triplenegative breast cancers, [26][27][28][29] and markers of mismatch repair (MMR) in colorectal cancer. 30,31 Key Principle Four Ensure rapid evaluation of each new treatment, which involves (a) incorporating the flexibility of phase II and III components into each trial and (b) targeting a reasonably large treatment effect, with discontinuation of random assignment to treatments that are unpromising or overwhelmingly effective as early and reliably as possible.-For the individual trials within the protocol, a larger effect size can be targeted than might be chosen in a more traditional trial.…”

Section: Key Principle Threementioning

confidence: 99%

Evaluating Many Treatments and Biomarkers in Oncology: A New Design

Kaplan

Maughan

Crook

et al. 2013

JCO

126

102

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There is a pressing need for more-efficient trial designs for biomarker-stratified clinical trials. We suggest a new approach to trial design that links novel treatment evaluation with the concurrent evaluation of a biomarker within a confirmatory phase II/III trial setting. We describe a new protocol using this approach in advanced colorectal cancer called FOCUS4. The protocol will ultimately answer three research questions for a number of treatments and biomarkers: (1) After a AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Although all authors completed the disclosure declaration, the following author(s) and/or an author's immediate family member(s) indicated a financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a "U" are those for which no compensation was received; those relationships marked with a "C" were compensated. Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts period of first-line chemotherapy, do targeted novel therapies provide signals of activity in different biomarker-defined populations? (2) If so, do these definitively improve outcomes? (3) Is evidence of activity restricted to the biomarker-defined groups? The protocol randomizes novel agents against placebo concurrently across a number of different biomarker-defined populationenriched cohorts: BRAF mutation; activated AKT pathway: PI3K mutation/absolute PTEN loss tumors; KRAS and NRAS mutations; and wild type at all the mentioned genes. Within each biomarker-defined population, the trial uses a multistaged approach with flexibility to adapt in response to planned interim analyses for lack of activity. FOCUS4 is the first test of a protocol that assigns all patients with metastatic colorectal cancer to one of a number of parallel population-enriched, biomarker-stratified randomized trials. Using this approach allows questions regarding efficacy and safety of multiple novel therapies to be answered in a relatively quick and efficient manner, while also allowing for the assessment of biomarkers to help target treatment.

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“…3 Nevertheless, the clinical utility of this categorization has been robust as a prognostic and predictive biomarker.…”

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confidence: 99%

Treating Triple-Negative Breast Cancer: Where Are We?

Morikawa

Seidman

2015

J Natl Compr Canc Netw

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Unlike estrogen receptor (ER)-positive and HER2-positive breast cancer, triple-negative breast cancer (TNBC) lacks a repertoire of targeted therapies. Hence, chemotherapy is the only available systemic option in current clinical practice. In general, survival of patients with TNBC is worse than that for those with ER-positive and HER2-positive breast cancer, especially for advanced-stage disease. Thus, a great unmet need exists. Conventional chemotherapeutic agents such as platinumsalts have been examined for specific benefit in TNBC; however, no one agent has yet been shown to offer a differential incremental benefit in metastatic TNBC. The hope is that ongoing research in targetable molecular pathways will lead to new therapeutic options for TNBC. Because these patients are likely to be increasingly subcategorized using potentially targetable molecular alterations, investigators will need to be mindful of the challenges in designing and conducting clinical trials in smaller subpopulations. The successful incorporation of targeted therapies in routine clinical practice for TNBC, which mirrors the success achieved by anti-HER2 and endocrine therapies, is awaited. (J Natl Compr Canc Netw 2015;13:(e8-e18) and rare types, such as adenoid cystic, metaplastic, apocrine, and neuroendocrine carcinoma.3 Nevertheless, the clinical utility of this categorization has been robust as a prognostic and predictive biomarker.Patients with TNBC are more likely to have a poor prognosis than those with estrogen receptor (ER)/ progesterone receptor (PR)-positive and/or HER2-positive breast cancer.4 This is likely partially attributable to a dearth of novel therapeutic options for TNBC, in contrast to the recent expansion of endocrine and anti-HER2 therapies (eg, ado-trastuzumab-emtansine, pertuzumab, everolimus with exemestane).5-7 Therefore, great interest has been shown in exploring potential biomarkers (prognostic and predictive) and developing new therapeutic options. This article reviews current treatment options ("where are we now?") and ongoing therapeutic research ("where are we going?") for TNBC. Heterogeneity of TNBCBecause the utilitarian definition of TNBC is simply based on the exclusion of ER/PR/HER2 expression, it is not unexpected that this clinical subtype remains biologically heterogeneous. Studies examining tumor characteristics have found correlations between TNBC and certain molecular genomic features, such as basal cytokeratin (eg, CK5/6) and epidermal growth factor receptor (EGFR) expression, checkpoint kinase (Chk1), p53 alterations, and BRCA1 germline mutations.8-13 TNBC has also been shown to have overlapping features with the basal-like subtype (intrinsic breast cancer classification), 14,15 including a high frequency of poorly differentiated tumors, expression of cytokeratins and EGFR, and p53 mutations. Although the basal-like-subtypes are most often triple-negative, they are not equivalent groups.16

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Triple negative breast cancer: Clinical characteristics in the different histological subtypes

Cited by 48 publications

References 24 publications

Dose invasive apocrine adenocarcinoma has worse prognosis than invasive ductal carcinoma of breast: evidence from SEER database

Dose invasive apocrine adenocarcinoma has worse prognosis than invasive ductal carcinoma of breast: evidence from SEER database

Evaluating Many Treatments and Biomarkers in Oncology: A New Design

Treating Triple-Negative Breast Cancer: Where Are We?

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