Neoadjuvant chemotherapy in triple‐negative breast cancer: A multicentric retrospective observational study in real‐life setting

Abstract

We aimed to assess the efficacy of neoadjuvant chemotherapy (NACT) in a cohort of 213 triple-negative breast cancer (TNBC) patients treated in real-world practice at eight Italian cancer centers. We computed descriptive statistics for all the variable of interest. Factors testing significant in univariate analysis were included in multivariate models. Survival data were compared by Kaplan-Meier curves and log-rank test. The median follow-up was 45 months. We observed 60 (28.2%) pathological complete response (pCR). The sequential anthracyclines-taxanes-based regimens produced the highest rate of pCR (42.6%), followed by concomitant anthracycline-taxane (24.2%), and other regimens (15.6%) (p = 0.008). When analyzing the role of baseline Ki-67, a 50% cut-off was the optimal threshold value for pCR prediction (p = 0.0005). The 5-year disease-free survival (DFS) was 57.3% and the 5-year overall survival (OS) was 70.8%. In patients not achieving pCR, the optimal Ki-67 variation between biopsy and surgical specimen with prognostic relevance on long-term outcomes was 13% (p = 0.04). Patients with a Ki-67 reduction (rKi-67)<13% had worse outcomes compared to those who experienced pCR or a rKi-67≥13%. The number of NACT cycles also affected long-term outcomes (5-year DFS 65.7% vs 51.6% in patients having received >6 cycles compared with their counterparts, p = 0.02). In multivariate analysis, node status, grading, and bio-pathological treatment response (including pCR and rKi-67) impacted DFS and OS. Our results confirmed the advantage conferred by more than 6 cycles of a sequential antracycline-taxane-based NACT. Higher baseline Ki-67 values shows greater predictive significance on pathogical response, while the rKi-67 plays a prognostic role on long-term outcomes.

PD-L1 Expression in TNBC: A Predictive Biomarker of Response to Neoadjuvant Chemotherapy?

“…We evaluated pre-NACT core biopsies, which proved to be qualitatively and quantitatively adequate for our analysis. In our study population, 35% of patients achieved a pCR, which is in line with recently published literature [ 21 , 22 ].…”

The influence of breast cancer subtypes on response to anthracycline neoadjuvant chemotherapy in locally advanced breast cancer patients

“…This difference was achieved on the account of the difference between non/luminal/HER2+ and luminal/HER2-BC subtypes. In our study, patients with TNBC achieved pCR of only 9.68%, a result which is not in line with newer literature data [30,31]. Although the small number of TNBC patients in our group compromises the interpretation of these results, low pCR rate noted in TNBC patients is in line with the recommendation that the combination of anthracycline and taxane chemotherapy is superior to anthracyclines alone [32].…”

A two-gene epigenetic signature for the prediction of response to neoadjuvant chemotherapy in triple-negative breast cancer patients

“…To our knowledge, the two genes epigenetic model shown in this study is the first epigenetic signature for prediction of response to NAC in TNBC patients. It should be noted that this model almost doubles the predictive potential described for the TNBC subtype by other approaches (~30-40% versus 78.6% with our model) [2][3][4][5][6].…”

“…At the present time, chemotherapy (CT) is the only proven therapy for triple-negative breast cancer (TNBC) subtype. Anthracycline and taxane-based CT is still the standard of care for TNBC [1], with pathological complete response (pCR) rates ranging~30-40% [2][3][4][5][6]. pCR rate in TNBC are associated with better outcomes while residual disease after neoadjuvant chemotherapy (NAC) have a higher relapse risk and poor prognosis [7].…”