IntroductionThe role of derived neutrophil-to-lymphocyte ratio (dNLR) in predicting the prognosis of patients with triple-negative breast cancer (TNBC) has not been well studied. Here, we attempted to investigate the significance of dNLR in predicting the prognosis of patients with surgical (nonmetastatic) TNBC.MethodsA total of 281 patients diagnosed with surgical TNBC in The First Affiliated Hospital of University of Science and Technology of China from February 2005 to March 2015 were retrospectively included in this study. Kaplan–Meier curve analysis was used to assess the disease-free survival (DFS) and overall survival (OS). We used Cox regression model to assess the prognostic significance of pretreatment dNLR and other clinicopathological parameters in TNBC patients.ResultsThe median DFS in TNBC patients who had low dNLR and high dNLR was 28.9 and 15.1 months (P<0.001), respectively, whereas the median OS in patients who had low dNLR and high dNLR was 71.2 and 42.3 months (P<0.001), respectively. In patients aged ≤50 years and with invasive ductal carcinoma, a low dNLR predicted better DFS and OS compared with a high dNLR. Multivariate analysis demonstrated that the increased dNLR was a risk factor of poor DFS (HR=1.90, 95% CI: 1.52–2.46, P=0.007) and OS (HR=2.56, 95% CI: 1.69–3.58, P=0.001).ConclusionPretreatment dNLR is an independent factor of prognosis for TNBC patients, which potentially allows clinical doctors to improve outcomes of patients with high dNLR by treating with aggressive therapy, such as high-dose adjuvant chemotherapy and radiotherapy.

background While neo-adjuvant anthracycline and taxane-based chemotherapy remains the standard of care for locally advanced TNBC, the optimal chemotherapy regimen is debatable. Anlotinib, a novel multi-target tyrosine kinase inhibitor that effectively inhibits VEGFR, FGFR, c-KIT, c-MET, and RET, monotherapy has been proven effective in HER-2 negative metastatic breast cancer. This study aims to evaluate the efficacy and safety of anlotinib combined with TEC in neo-adjuvant treatment for locally advanced TNBC, and to evaluate the value of predicting pathological response by multi-point core needle biopsy during neo-adjuvant therapy. method This study retrospectively analyzed 18 patients (Pts) with locally advanced triple-negative breast cancer who received anlotinib combined with TEC neo-adjuvant therapy and surgical treatment from August 2020 to January 2022 in the Breast Diagnosis and Treatment Center of Anhui Cancer Hospital. Pts with clinical stage IIb/III TNBC were to be treated with 6 cycles of anlotinib (12mg, d1-14, q3w) plus 6 cycles of docetaxel (75 mg/m2, d1, q3w), Epirubicin (90 mg/m2, d1, q3w) and cyclophosphamide (600 mg/m2, d1, q3w) followed by surgery. Before the fifth cycle of treatment, ultrasound-guided multi-point Core needle biopsy was performed to evaluate the efficacy of neo-adjuvant therapy and predict the pathological complete response, as well as to guide the selection of surgical methods. The primary endpoint was pathological complete response (pCR, ypT0/is). Result Eighteen pts, the median age was 48 years (range, 23-60), were included in the statistical analysis. All patients completed 6 cycles of anlotinib combined with TEC neo-adjuvant therapy followed by radical mastectomy for breast cancer. Regarding pathological response, there were 4 (22.2%), 2 (11.1%), and 12 (66.7%) patients realizing Miller-Payne grade G3, G4, and G5, respectively. Besides, 12 (66.7%) patients achieved pCR. Additionally, the accuracy of multi-point core needle biopsy in predicting pCR was 94.4% in the interval between neo-adjuvant therapy. The grade 3 or 4 AEs were neutropenia and thrombocytopenia in 3 cases each, anemia, arrhythmia, and ALT increased in cases 1 case each. One patient dropped out of the group due to tumor rupture and bleeding. conclusion Anlotinib combined with TEC as neo-adjuvant therapy showed manageable toxicity and promising antitumor activity for locally advanced TNBC. It is safe, reliable, feasible and accurate to evaluate the efficacy of neo-adjuvant therapy and to predict pathological complete response by multi-point core needle biopsy. It means that the clinical evaluation of neo-adjuvant therapy can transition from imaging evaluation to pathological evaluation, which is helpful for the choice of surgical methods. Citation Format: Kuojun Ren, Shikai Hong, Zhengzhi Zhu, Shengying Wang, Jianjun Liu, Hong Gao, Shuhan Wang. The Efficacy of Anlotinib Combined with TEC in Neo-adjuvant Treatment for Triple-Negative Breast Cancer and The Value of Multi-point Core Needle Biopsy in Prediction of Pathologic Complete Remission: A Retrospective analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-01-08.