Clinical outcome of triple-negative breast cancer with BRCA mutation in the context of dose-dense and or metronomic chemotherapy.

Abstract

1109 Background: Patients with triple negative (TN) breast cancer have a high risk of early relapse and death, but have promising outcomes with dose-dense and or metronomic combination chemotherapy in BRCA-unselected cohort (rsmehta JCO 2008). With the TN breast cancer, emerging data suggests that patients with BRCA mutations treated with chemotherapy have similar outcomes as sporadic TN breast cancer. Methods: Retrospective review of 88 patients with stage I to IIIB TN breast cancer who were treated with adjuvant or neoadjuvant chemotherapy was performed. Fifteen patients (18%) were found to have BRCA mutation (12 with BRCA1 and 3 with BRCA2 mutation) while 69 patients were either negative for BRCA mutation or were not tested. Patients were treated with various regimens, but could be grouped according to the receipt of dose-dense and or metronomic (DD) versus standard (Std) chemotherapy schedules. The median follow-up was 41 months (range 4-155 months). Results: Grade, histology and stage were not significantly different between carriers and noncarriers. Mean age of carriers was 39 versus 50 for noncarriers. Relapse-free-survival survival at 3 years was 100% for carriers and 70% for noncarriers (P =0.15). Overall survival at 3 years was 100% for carriers and 83% for noncarriers (P = <0.05). In addition, stage and treatment (DD vs Std) were significant in univariate analysis. Adjusting for carrier status, stage, and treatment, only stage and treatment remained significant for relapse-free and overall survival. Conclusions: Our data supports the emerging data that shows that BRCA mutation carriers with TN disease had similar survival rates to noncarriers. Dose-dense and or metronomic schedules outperformed standard chemotherapy schedules in TN breast cancer irrespective of BRCA mutation status.