Association of Adjuvant Chemotherapy With Overall Survival Among Women With Small, Node-Negative, Triple-Negative Breast Cancer

Abstract Background Triple negative breast cancer (TNBC) (estrogen receptor (ER) – negative, progesterone receptor (PR) - negative, and human epidermal growth factor receptor 2 (HER2) -negative) is an aggressive subtype of breast cancer that is more common in younger women, carries a poorer prognosis and has a greater metastatic potential than receptor positive subtypes. Radiation therapy’s ability to improve outcomes, especially the overall survival is controversial, more so among African American patients. The objective of this study is to evaluate local control and survival rates of TNBC patients treated with radiotherapy (RT) in our institution with a sizeable cohort of African American women. Methods This is a retrospective analysis of 67 TNBCs (2007–2017) at an academic state institution who underwent a lumpectomy and /or mastectomy (surgery) followed by adjuvant irradiation to a median total dose of 50 Gy (range 40.5–50.40 Gy). Chemotherapy was administered in a neoadjuvant (32) or adjuvant setting (35). For all 67 TNBCs, local control (LC), overall survival (OS), and disease-free survival (DFS) were estimated using the Kaplan-Meier method. The significance of survival variables was analyzed using the Cox univariate and multivariate proportional hazards model. A p-value of less than 0.05 was considered statistically significant. The SPSS 24.0 software was used for data analysis. Results The baseline characteristics of all 67 TNBCs were measured with median follow up of 58 months (range 10–142 months). Patients were stratified into two groups (neoadjuvant chemotherapy-RT (32) vs. adjuvant chemotherapy-RT (35)). The five-year rates for LC, DFS and OS were 14.8 % vs. 47.9 % (p = 0.002), 24.2% vs. 53.1 % (p = 0.015), and 65.1% vs. 92.2% (0.002) respectively. On Cox multivariate analysis, patients who received adjuvant chemotherapy were associated with statistically improved significant LC (p = 0.002) and OS (p = 0.002). The variables included were: BMI (p = 0.050), distance travelled (p = 0.027), 8th AJCC TNM staging (p = 0.018) and tumor grade (p = 0.022). Conclusion In this hypothesis-generating report, among TNBC patients undergoing RT, adjuvant chemotherapy appears to be better than neoadjuvant chemotherapy in determining the clinical outcomes.

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Adjuvant chemotherapy in small node-negative triple-negative breast cancer

European Journal of Cancer ◽

10.1016/j.ejca.2020.04.033 ◽

2020 ◽

Vol 135 ◽

pp. 66-74

Author(s):

Tessa G. Steenbruggen ◽

Erik van Werkhoven ◽

Mette S. van Ramshorst ◽

Vincent O. Dezentjé ◽

Marleen Kok ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Node Negative

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Benefit of adjuvant chemotherapy in node-negative T1a versus T1b and T1c triple-negative breast cancer

Breast Cancer Research and Treatment ◽

10.1007/s10549-021-06481-4 ◽

2022 ◽

Author(s):

Genevieve A. Fasano ◽

Solange Bayard ◽

Yalei Chen ◽

Leticia Varella ◽

Tessa Cigler ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Node Negative

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Benefit of Adjuvant Chemotherapy in Node-Negative T1a Versus T1b and T1c Triple Negative Breast Cancer

10.21203/rs.3.rs-625370/v1 ◽

2021 ◽

Author(s):

Genevieve A Fasano ◽

Solange Bayard ◽

Yalei Chen ◽

Leticia Varella ◽

Tessa Cigler ◽

...

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Triple Negative Breast Cancer ◽

Tumor Size ◽

Triple Negative ◽

The United States ◽

Adjuvant Radiation ◽

Node Negative ◽

Cancer Network

Abstract Purpose: National Comprehensive Cancer Network guidelines recommend delivery of adjuvant chemotherapy in node-negative triple negative breast cancer (TNBC) if the tumor is > 1 cm and consideration of adjuvant chemotherapy for T1b but not T1a disease. These recommendations are based upon sparse data regarding the role of adjuvant chemotherapy in T1a and T1b node-negative TNBC. Our objective was to clarify the benefits of chemotherapy for patients with T1N0 TNBC, stratified by tumor size.Methods: We performed a retrospective analysis of survival outcomes in an IRB-approved prospectively-maintained database of TNBC patients treated at two academic institutions in the United States from 1999-2018. Primary tumor size, histology, and nodal status were based upon definitive surgical pathology. Mean follow-up was 5.3 years.Results: 756 TNBC cases were analyzed; 258 T1N0 TNBC patients were identified. Adjuvant chemotherapy was delivered to 30.5% of T1a, 64.7% T1b, and 83.9% T1c (p < 0.0001). Factors associated with delivery of adjuvant chemotherapy were age, histology, high-grade disease, and postoperative adjuvant radiation therapy. At a mean follow-up of 5.3 years, increase in overall survival was associated with use of chemotherapy in patients with T1c disease (93.2% v. 75.2% p = 0.008) but not in those with T1a (100% v. 100% p = 0.3778) or T1b (100% v. 95.8% p = 0.2362) disease.Conclusion: Our data support current guidelines indicating benefit from adjuvant chemotherapy in node-negative TNBC associated with T1c tumors but excellent outcomes were observed in cases of T1a and T1b disease, regardless of whether adjuvant chemotherapy was delivered.

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Is there a survival benefit with adjuvant chemotherapy for patients with stage I (T1N0) triple negative breast cancer?

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e11547 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e11547-e11547

Author(s):

T. H. Luu ◽

S. Lau ◽

R. Nelson ◽

M. Ottochian ◽

A. Garcia ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Triple Negative Breast Cancer ◽

Survival Benefit ◽

Triple Negative ◽

Stage I ◽

P Value ◽

Breast Cancer Patients

e11547 Background: Chemotherapy is the only systemic modality for patients with breast cancer lacking expression of estrogen, progesterone, and HER2 receptors (triple negative), a group comprising 15% of all breast cancers. The majority of such patients present with nodal metastases. The median time to distant recurrence is short: at 2.6 years, and median time to death is 4.2 years. (Dent R, et al. Triple-Negative Breast Cancer: Clinical Features and Patterns of Recurrence, Clin Cancer Res 2007; 13(15) August, 2007). The benefit from proceeding with adjuvant chemotherapy for ≤2cm, node negative triple negative breast cancer remains undefined. Patients and Methods: A retrospective chart review was conducted to assess the benefit of adjuvant chemotherapy for overall survival for stage I (T1N0) triple-negative breast cancer treated from 1996 to 2006 at City of Hope and USC. ER, PR, and HER2 status (as assessed by fluorescent in-situ hybridization (FISH) or immunohistochemistry) were reviewed and confirmed. Overall survival was defined as time from date of diagnosis to date of death. All patients received standard surgery ± radiation. Results: A total of 100 stage I triple-negative breast cancer patients were identified. The median age at diagnosis was 56 (range 27–91). Of the 100 patients, 59 received adjuvant chemotherapy: 38 received anthracycline-based, 17 received non-anthracycline-based regimens and 4 were unknown. Median length of follow-up was 4.0 years. No difference in overall survival was found in patients who received adjuvant chemotherapy (p-value = 0.94). Similarly, there was no difference between patients who received non-anthracycline-based chemotherapy versus those given anthracycline-based chemotherapy (p-value=0.17). The group of patients who received adjuvant chemotherapy were younger (51.8 y.o versus 61.5 y.o (p=0.0004)) and had larger tumor size (13.6mm versus 10.2mm (p=0.0002)). Lack of statistical significance may be related to the limited sample size. Conclusion: We did not find a statistically survival benefit of adjuvant chemotherapy in 100 triple negative stage I breast cancer patients. Further studies are needed to clarify the role of adjuvant chemotherapy in this group of patients. No significant financial relationships to disclose.

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Role of adjuvant chemotherapy in small (≤5 mm) node-negative and hormone receptor-negative breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e12021 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e12021-e12021

Author(s):

Samip R. Master ◽

Neelakanta Dadi ◽

Chintan Shah ◽

Gary Von Burton ◽

Runhua Shi

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Hormone Receptor ◽

Triple Negative ◽

Outcome Variable ◽

Node Negative ◽

Risk Of Death ◽

Node Negative Breast Cancer

e12021 Background: There is currently lack of adequate data to support for or against the role of adjuvant chemotherapy for small( < = 5mm) hormone negative and node negative breast cancer. We did a retrospective analysis from National Cancer Database (NCDB) to assess the effect of adjuvant chemotherapy in HER2 positive/ Hormone receptor negative (HER+HR-) and triple negative breast cancer. Methods: Data was analyzed from approximately nine thousand women registered in the (NCDB) who were diagnosed with triple negative and HER+ HR-small ( < = 5mm) and node negative breast cancer between 2010 and 2014 and had follow-up to the end of 2015. The primary predictor variable was the receipt of chemotherapy, and outcome variable was overall survival. Additional variables addressed and adjusted included age, race, Charlson Comorbidity Index and grade of cancer. Results: Approximately 59% patients received adjuvant chemotherapy. The five year overall survival in women with triple negative for breast cancer who received chemotherapy was 79% , compared to 87% , for those who did not receive chemotherapy(p < 0.00001). The five year overall survival in women with Her2+HR- for breast cancer who received chemotherapy was 68% , compared to 84% , for those who did not receive chemotherapy(p < 0.00001).In multivariate analysis, after adjusting for secondary predictor variables, avoidance of adjuvant chemotherapy was associated with 59.5% reduction in risk of death. Conclusions: Our analysis suggests that there are no role for adjuvant chemo in small breast cancers that are Her+ HR- and triple negative. The receipt of adjuvant chemotherapy lead to decrease in overall survival.

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