Journal of Clinical Oncology, Vol 26, No 8 (March 10), 2008: pp. 1275-1281
Response to Neoadjuvant Therapy and Long-Term Survival in Patients With Triple-Negative Breast Cancer
Kenneth R. Hess,
Jaime A. Mejia,
W. Fraser Symmans,
Ana M. Gonzalez-Angulo,
Gabriel N. Hortobagyi,
From the Departments of Breast Medical Oncology, Biostatistics and
Applied Mathematics, and Pathology, The University of Texas M.D.
Anderson Cancer Center, Houston, TX; Department of Gynecology and
Obstetrics, University of Münster, Münster, Germany; Department of
Obstetrics and Gynecology, Marseille Public Hospital System, Marseille;
and Breast Cancer Unit and Translational Research Unit UPRES03535,
Institut Gustave Roussy, Villejuif, France
Corresponding author: Lajos Pusztai, MD, PhD,
Department of Breast Medical Oncology, Unit 1354, The University of
Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX
77030-1439, USA; e-mail: firstname.lastname@example.org
Purpose Triple-negative breast cancer (TNBC) is defined by the lack of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) expression. In this study, we compared response to neoadjuvant chemotherapy and survival between patients with TNBC and non-TNBC.
Patients and Methods Analysis of a prospectively collected clinical database was performed. We included 1,118 patients who received neoadjuvant chemotherapy at M.D. Anderson Cancer Center for stage I-III breast cancer from 1985 to 2004 and for whom complete receptor information were available. Clinical and pathologic parameters, pathologic complete response rates (pCR), survival measurements, and organ-specific relapse rates were compared between patients with TNBC and non-TNBC.
Results Two hundred fifty-five patients (23%) had TNBC. Patients with TNBC compared with non-TNBC had significantly higher pCR rates (22% v 11%; P = .034), but decreased 3-year progression-free survival rates (P < .0001) and 3-year overall survival (OS) rates (P < .0001). TNBC was associated with increased risk for visceral metastases (P = .0005), lower risk for bone recurrence (P = .027), and shorter postrecurrence survival (P < .0001). Recurrence and death rates were higher for TNBC only in the first 3 years. If pCR was achieved, patients with TNBC and non-TNBC had similar survival (P = .24). In contrast, patients with residual disease (RD) had worse OS if they had TNBC compared with non-TNBC (P < .0001).
Conclusion Patients with TNBC have increased pCR rates compared with non-TNBC, and those with pCR have excellent survival. However, patients with RD after neoadjuvant chemotherapy have significantly worse survival if they have TNBC compared with non-TNBC, particularly in the first 3 years.