Response to Neoadjuvant Therapy and Long-Term Survival in Patients With Triple-Negative Breast Cancer

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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
Cornelia Liedtke,
Chafika Mazouni,
Kenneth R. Hess,
Fabrice André,
Attila Tordai,
Jaime A. Mejia,
W. Fraser Symmans,
Ana M. Gonzalez-Angulo,
Bryan Hennessy,
Marjorie Green,
Massimo Cristofanilli,
Gabriel N. Hortobagyi,
Lajos Pusztai


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:

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.