Abstract
PurposeIncomplete response to neoadjuvant chemotherapy (NACT) in triple negative breast cancer (TNBC) patients is correlated to high risk of relapse. This study aimed to evaluate the role of adjuvant chemotherapy in TNBC with residual tumor after NACT. MethodsWe retrospectively reviewed the outcome of patients with TNBC with residual tumor at surgery after a neoadjuvant treatment, followed by either adjuvant chemotherapy or observation. Primary endpoints were Disease Free Survival (DFS) and Overall Survival (OS). ResultsBetween January 2000 and December 2016, 223 patients with early TNBC operated at the European Institute of Oncology were eligible. A total of 83.4 % of patients received adjuvant chemotherapy after surgery. 90 patients received standard dose infusional regimens, while 96 patients (51.6 %) received oral metronomic chemotherapy. Adjusting the analysis by surgical stage and Ki67 value there was a benefit for DFS and OS in favor of the group that received postoperative chemotherapy (DFS-HR 0.58 p = 0.04; OS-HR 0.54, p = 0.02). At a subgroup analysis according to the different adjuvant treatments received, a benefit for metronomic chemotherapy versus no chemotherapy both for DFS (HR 0.46, p = 0.008) and OS (HR 0.45, p = 0.009) was reported. ConclusionOur retrospective analysis in a large cohort of TNBC patients with residual disease after NACT confirms the benefit of adding a postoperative treatment to reduce risk of relapse and death. Based on these results, we suggest that the adjuvant therapy based on metronomic cyclophosphamide and methotrexate deserves further investigation in this patients population.
Highlights
Despite the multimodal treatment, which includes surgery and chemotherapy, triple negative breast cancer (TNBC) is associated to a poor prognosis [1]
We considered all patients with a diagnosis of triple negative pathologically residual invasive breast cancer in the surgical specimen of the breast or axillary lymph nodes after completion of neoadjuvant chemotherapy
Triple negative breast cancer was defined as estrogen and progesterone receptors staining by immunohistochemistry (IHC) inferior to 1 % and human epidermal growth factor receptor 2 (HER2) negative with an IHC result of 0 or 1þ for cellular membrane protein expression or an in situ hybridization (ISH) negative result in accordance with recent reports [10,11]
Summary
Despite the multimodal treatment, which includes surgery and chemotherapy, triple negative breast cancer (TNBC) is associated to a poor prognosis [1]. The standard treatment for TNBC patients is the neoadjuvant chemotherapy (NACT) which has been shown to be effective in reducing the size of locally advanced breast cancer and keeping the disease under control in the most aggressive subtypes. A retrospective analysis conducted on patients enrolled in two randomized clinical trials with node negative breast cancer, showed the benefits obtained from adjuvant classical CMF (cyclophosphamide/ methotrexate/5-fluorouracil) in triple negative subtype [8]. Alkylating agents-based regimens could be considered as post-neoadjuvant chemotherapy for TNBC with residual disease. The aim of this retrospective study was to explore the benefit of adjuvant chemotherapy in a large series of TNBC patients with pathological residual disease after NACT. A comparison for benefit among different adjuvant regimens used was investigated
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