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Observational Study
. 2016;23(6):291-302.
doi: 10.3727/096504016X14562725373879.

Neoadjuvant Chemotherapy in Triple Negative Breast Cancer: An Observational Study

Zhiying Shao  1 , Shalini Chaudhri, Meng Guo, Longzhen Zhang, Daniel Rea
Affiliations
Observational Study

Neoadjuvant Chemotherapy in Triple Negative Breast Cancer: An Observational Study

Zhiying Shao et al. Oncol Res. 2016.

Abstract

Triple negative breast cancer (TNBC) is a phenotype of breast cancer with aggressive clinical behavior. Because of the absence of optimal treatment, the prognosis of this disease is poor. The main purpose of this study was to detect the response to neoadjuvant chemotherapy (NACT) in a TNBC cohort and compare the long-term survival between patients with and without pathological complete response (pCR). A total of 53 patients diagnosed with TNBC from 2005 to 2013 who received NACT at the University Hospital Birmingham were enrolled in this study. Overall survival (OS) and progression-free survival (PFS) were compared between the pCR group and non-pCR group. Demographic information and clinical or pathologic parameters were also analyzed to explore potential predictive and prognostic factors. Fourteen patients (26.4%) achieved pCR to NACT. In univariate analysis, patients with pCR had longer PFS time (p = 0.013) and OS time (p = 0.054) compared with their counterparts without pCR. In multivariate analysis, the existence of lymphovascular invasion (LVI) significantly reduced OS (HR = 17.404, 95% CI = 2.923-103.644) and PFS (HR = 7.776, 95% CI = 1.645-36.753). The achievement of pCR to NACT can significantly postpone the incidence of disease progression in patients with TNBC. There is not enough evidence showing its influence on ultimate survival. LVI may be a more potent prognostic factor than pCR in the TNBC cohort.

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Figures

Figure 1
Figure 1
Waterfall plots of best percent change from baseline in measurable tumor during neoadjuvant chemotherapy courses. Different responses were in different patterned bars. Among them, 33.3% of patients receive clinical complete response (CR) from baseline, 46.7% of patients received clinical partial response (PR), and 17.0% of patients received stable disease (SD).
Figure 2
Figure 2
Percentages of patients who achieved pathological complete response (pCR) and patients who did not receive pCR. A total of 14 patients received pCR after neoadjuvant chemotherapy, while 36 patients still had residual tumor in breast or axillary lymph nodes. Three patients had missing values.
Figure 3
Figure 3
Long-term survival in all TNBC patients and the comparison between patients with pCR and those with no pCR. (a) OS in all TNBC patients, (b) PFS in all TNBC patients, (c) comparison of OS in patients with pCR (upper line) and those without pCR (lower line), (d) comparison of PFS in patients with pCR (upper line) and those without pCR (lower line). Dashed line refers to the level of median survival rates. Patients with pCR had improved OS and PFS compared with their non-pCR counterparts.
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