scholarly journals Survival, treatment regimens and medical costs of women newly diagnosed with metastatic triple-negative breast cancer

2022 ◽  
Vol 12 (1) ◽  
Ju-Yi Hsu ◽  
Chee-Jen Chang ◽  
Jur-Shan Cheng

AbstractIndividuals diagnosed with metastatic triple-negative breast cancer (mTNBC) suffer worse survival rates than their metastatic non-TNBC counterparts. There is little information on survival, treatment patterns, and medical costs of mTNBC patients in Asia. Therefore, this study aimed to examine 5-year survival, regimens of first-line systemic therapy, and healthcare costs of mTNBC patients in Taiwan. Adult females newly diagnosed with TNBC and non-TNBC as well as their survival data, treatment regimens and costs of health services were identified and retrieved from the Cancer Registry database, Death Registry database, and National Health Insurance (NHI) claims database. A total of 9691 (19.27%) women were identified as TNBC among overall BC. The 5-year overall survival rate of TNBC and non-TNBC was 81.28% and 86.50%, respectively, and that of mTNBC and metastatic non-TNBC was 10.81% and 33.46%, respectively. The majority of mTNBC patients received combination therapy as their first-line treatment (78.14%). The 5-year total cost in patients with metastatic non-TNBC and with mTNBC was NTD1,808,693 and NTD803,445, respectively. Higher CCI scores were associated with an increased risk of death and lower probability of receiving combination chemotherapy. Older age was associated with lower 5-year medical costs. In sum, mTNBC patients suffered from poorer survival and incurred lower medical costs than their metastatic non-TNBC counterparts. Future research will be needed when there are more treatment options available for mTNBC patients.

2019 ◽  
Vol 8 (14) ◽  
pp. 1173-1185 ◽  
Patricia Luhn ◽  
Stephen Y Chui ◽  
“Angela” Fu-Chi Hsieh ◽  
Jingbo Yi ◽  
Almut Mecke ◽  

Aim: This observational study evaluated the effectiveness of nab-paclitaxel versus paclitaxel monotherapy as first-line (1L) treatment for metastatic triple-negative breast cancer (mTNBC). Materials & methods: 200 patients from the US Flatiron Health electronic health record-derived database (mTNBC diagnosis, January 2011–October 2016) who received 1L nab-paclitaxel (n = 105) or paclitaxel (n = 95) monotherapy were included. Overall survival and time to next treatment were evaluated. Results: The adjusted overall survival hazard ratio was 0.98 (95% CI: 0.67–1.44), indicating a similar risk of death between groups. Adjusted time to next treatment hazard ratio was 0.89 (95% confidence interval: 0.62–1.29). Conclusion: Nab-paclitaxel and paclitaxel monotherapy showed similar efficacy, suggesting their interchangeability as 1L treatments for mTNBC.

2020 ◽  
pp. 75-80
S.A. Lyalkin ◽  
L.A. Syvak ◽  
N.O. Verevkina ◽  

The objective: was to evaluate the efficacy of the first line chemotherapy in patients with metastatic triple negative breast cancer (TNBC). Materials and methods. Open randomized study was performed including 122 patients with metastatic TNBC. The efficacy and safety of the first line chemotherapy of regimens АТ (n=59) – group 1, patients received doxorubicine 60 мг/м2 and paclitaxel 175 мг/м2 and ТР (n=63) – group 2, patients received paclitaxel 175 мг/м2 and carboplatin AUC 5 were evaluated. Results. The median duration of response was 9.5 months (4.5–13.25 months) in patients received AT regimen and 8.5 months (4.7–12.25 months), in TP regimen; no statistically significant differences were observed, р=0.836. The median progression free survival was 7 months (95% CI 5–26 months) in group 1 and 7.5 months (95% CI 6–35 months) in group 2, p=0.85. Both chemotherapy regimens (AT and TP) had mild or moderate toxicity profiles (grade 1 or 2 in most patients). No significant difference in gastrointestinal toxicity was observed. The incidence of grade 3–4 neutropenia was higher in patients of group 2 (TP regimen): 42.8% versus 27% (р<0.05). Conclusions. Both regimens of chemotherapy (AT and TP) are appropriate to use in the first line setting in patients with metastatic TNBC. Key words: metastatic triple negative breast cancer, chemotherapy, progression free survival, chemotherapy toxicity.

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A24-A24
Georges Azzi ◽  
Shifra Krinshpun ◽  
Antony Tin ◽  
Allyson Malashevich ◽  
Meenakshi Malhotra ◽  

BackgroundTriple negative breast cancer (TNBC) is an aggressive form of breast cancer that is most difficult to treat due to the absence of hormone/growth factor receptors.1 2 Metastatic TNBC (mTNBC) is particularly challenging, given the limited efficacy and duration of response to chemotherapy.3 The repertoire of therapeutic options for mTNBC patients continues to increase with chemotherapeutic and immuno oncology based treatments and now includes sacituzumab govitecan, a novel antibody-chemotherapy conjugate.4MethodsHere we present a case study of a 40-year-old female who on biopsy of her left breast mass was diagnosed with TNBC. The patient underwent neoadjuvant chemotherapy with weekly administration of paclitaxel and carboplatin followed by dose-dense doxorubicin with cyclophosphamide. Following one-month, the patient underwent bilateral mastectomy, showing pathological staging ypT2 pN0. The patient underwent periodic radiological imaging along with the assessment of circulating tumor DNA in blood using a personalized and tumor-informed multiplex PCR, next-generation sequencing assay (Signatera bespoke, mPCR NGS assay) to identify the minimal residual disease (MRD) and treatment response.ResultsAfter surgery, MRD assessment revealed ctDNA positive status (0.41 MTM/mL) prompting PET/CT scan that revealed liver metastasis. Continued ctDNA monitoring showed continuous increase in ctDNA concentration (287.09 MTM/mL). Separate analyses indicated MSI-high and PD-L1 positive tumor status, leading to the initiation of the first line of therapy (nab-paclitaxel and Atezolizumab), which resulted in ctDNA decline (39.62 MTM/ml). Weekly ctDNA monitoring noted a rapid increase a month later (178 MTM/ml to 833.69 MTM/ml) within a 2-week interval, which corresponded to disease progression on imaging. Given non-responsiveness with the first-line therapy, the patient was initiated with sacituzumab govitecan. Following this, a rapid decline in the ctDNA level was observed within a week (364.07 MTM/mL) with a downward trend to 73.03 MTM/ml by two weeks. An interval PET/CT scan showed a mixed response. Continued monitoring of ctDNA demonstrated ctDNA levels <5MTM/mL for a period of two months before serially rising again (to 89.27 MTM/ml). PET-CT ordered in response to increasing ctDNA levels confirmed progression involving hepatic and lung lesions. A new line of therapy with nivolumab and ipilimumab was subsequently initiated.ConclusionsSerial monitoring of ctDNA enables early detection of therapy resistance and provides a rationale for treatment change/optimization/discontinuation as compared to periodic imaging that is currently the standard of care. The ease and convenience of using ctDNA-based testing as frequently as every week clearly identified earlier non-responsiveness to IO and also identified earlier acquired resistance to antibody-drug conjugate, enabling a prompt switch to alternative therapy.Ethics ApprovalN/AConsentN/AReferencesAnders C, Carey LA. Understanding and treating triple-negative breast cancer. Oncology (Williston Park). 2008;22(11):1233–1243.Mehanna J, Haddad FG, Eid R, Lambertini M, Kourie HR. Triple-negative breast cancer: current perspective on the evolving therapeutic landscape. Int J Womens Health2019;11:431–437. Published 2019 Jul 31. doi:10.2147/IJWH.S178349Treatment of Triple-negative Breast Cancer. American Cancer Society Website. Updated 2020. Accessed August 10, 2020. A, Mayer IA, Vahdat LT, et al. Sacituzumab govitecan-hziy in refractory metastatic triple-negative breast cancer. N Engl J Med 2019;380(8):741–751. doi:10.1056/NEJMoa1814213

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Hesham Ahmed ElGhazaly ◽  
Manal Mohamed El-Mahdy ◽  
Azza Mohamed Adel ◽  
Nermeen Mostafa ◽  
Aya Magdy Kamal Ali

Abstract Background TNBC comprises a distinct disease entity with a unique microenvironment of TILs, the immunogenic potential of TNBC is derived from its genetic instability and high mutation rate. Tumors from patients with TNBC are more likely than tumors from patients with other subtypes to exhibit chromosomal instability and potential mutations. Objectives The study aims to evaluate the prevalence of CD8+ TILs biomarker by IHC in triple negative breast cancer and its prognostic value. TILs are an important prognostic value for the response of patient to chemotherapy the greater number of TILS is associated with higher probability of response to chemotherapy also decrease recurrence. TILS in triple negative breast cancer suggest a likely option for immunotherapy in this disease. Patients and Methods This is a retrospective study, which was carried on 30 female patients, Clinical data and paraffin wax block of female patients with triple negative breast cancer are to be collected from the breast cancer unit, department of clinical Oncology and Nuclear medicine Ain Shams university and Matarya teaching hospital. Results Several large systematic reviews and meta-analyses have confirmed that high levels of TILs are associated with better disease free survival and overall survival only in triple negative and HER2 positive subtypes, with no significant benefit seen in estrogen receptor positive breast carcinoma. In the Breast International Group (BIG) 02-98 trial shows that for every 10% increase in the intertumoral TILs there was a 17% reduced risk of relapse, and 27% reduced risk of death regardless of chemotherapy type. Also in eastern cooperative oncology group trial (ECOG) 2197, and 1199 showed that for every 10% increase in TILs, a 14% reduction of risk of recurrence, and 19% reduction in risk of death were observed. Conclusion Our study showed that All our patients (100%) were positive for CD8+, with a minimum range of 1% and a maximum range of 60%, most of the patients (20 patients) had CD8% between (10% to 20%). High levels of CD8 + TILs are good prognostic indicators in TNBC. our study showed that there were associations of CD8+ TILs infiltrate status with longer progression free survival and better overall survival in triple-negative breast cancer, but were not statistically significant probably due to our small sample size.

2020 ◽  
Vol 7 (1) ◽  
pp. 55-65
A. A. Kharitonova ◽  
I. A. Smirnova ◽  
M. V. Kiseleva

By far the most aggressive subtype of breast cancer is triple negative cancer. The purpose of this review is to analyze current ideas about the pathogenesis, clinical characteristics of different subtypes of triple negative breast cancer, the nature of its metastasis, mechanisms of chemoresistance. The review presents the results of modern regimens of drug therapy of triple negative breast cancer according to the publications of domestic and foreign oncologists. On the basis of various clinical studies, the effectiveness of the use of anthracyclines, taxanes in the dose-dense regime, platinum preparations and other chemotherapy drugs for the treatment of triple-negative cancer has been shown. The presented treatment regimens allow to achieve a complete morphological response in 85% of patients, to increase the rates of relapse-free and overall survival, comparable with other subtypes of breast cancer. The review highlights the possibilities of modern targeted drugs-PARP inhibitors, chk1 inhibitors UCN‑01, immunotherapy possibilities for the treatment of this aggressive subtype of breast cancer.

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