Abstract P5-08-07: The long-term prognosis of breast cancers patients diagnosed ≤40 years in the absence of adjuvant systemic therapy

e12596 Background: Triple negative breast cancers (TNBC), characterized by the lack of expression of estrogen receptors and progesterone receptors as well as human epidermal growth factor receptor 2, are associated with high distant recurrence rate and death. As a result, the majority of patients with TNBC are treated with perioperative chemotherapy with the goal of eradicating micrometastases and preventing distrant relapse. The preoperative systemic therapy offers the advantages of permitting an assessment of chemo-sensitivity, increased rates of breast conserving surgery and the ability to adapt postoperative therapies depending on the response. Recently, neoadjuvant chemotherapy has been used at an increasing frequency. The response to neoadjuvant chemotherapy, as measured by the residual cancer burden index, for example, is correlated with the long-term prognosis of TNBC and HER2 expressing breast cancers. Previous studies suggest that tumor-infiltrating lymphocytes (TILs) may correlate with pathological complete response (pCR) rates in TNBC patients treated with neoadjuvant chemotherapy. The pathologic evaluation of TILs in TNBC has been recommended by the International TILs working group since 2014. In this study we sought to analyze the association of TILs with pCR in a cohort of TNBC patients treated with neoadjuvant chemotherapy. Methods: An IRB-approved single-institution retrospective analysis was performed on 127 patients diagnosed with TNBC who received neoadjuvant anthracycline and taxane based chemotherapy at the Ohio State University Comprehensive Cancer Center between January 1st, 2012 and November 31st, 2018. We analyzed TILs as a continuous variable as a part of a secondary analysis of this data. Whole tissue sections from archived H&E stained glass slides were scanned using Philips UltraFast Scanner at ×40 magnification with a single-focus layer. TIL scoring was performed according to guideline recommendations from the International TILs Working Group (2014). Results: A total of 127 female patients with TNBC were identified. The median age at diagnosis was 52.0 years (range 32.0, 74.0) and patients were predominately white (103, 81%), post-menopausal (68, 53.5%) and presented with invasive ductal cancer (113, 89%), stage II (88, 69%), and high grade (108, 85%). Of those patients, 56 had TILs measurement available. pCR was associated with statistically higher level of TILs in core biopsies taken prior to chemotherapy had (Wilcoxon rank-sum test, p = 0.04). Conclusions: The long-term prognosis of patients with TNBC is predicted by the response to neoadjuvant chemotherapy. Consistent with other studies, our study revealed that TILs are associated with a higher probability of pCR. Our future goals are to identify which TIL subsets correlate best with pCR and to identify the mechanism for the increased chemotherapy responsiveness of lymphocyte-infiltrated tumors.

Download Full-text

Long-term prognosis is associated with residual disease after neoadjuvant systemic therapy but not with initial nodal status

European Journal of Cancer ◽

10.1016/s0959-8049(20)30574-8 ◽

2020 ◽

Vol 138 ◽

pp. S22

Author(s):

L. Zetterlund ◽

F. Celebioglu ◽

J. Frisell ◽

J. de Boniface

Keyword(s):

Systemic Therapy ◽

Residual Disease ◽

Nodal Status ◽

Neoadjuvant Systemic Therapy ◽

Long Term Prognosis

Download Full-text

Prognosis and Management of Patients With Node-Negative Invasive Breast Carcinoma That Is 1 cm or Smaller in Size (stage 1; T1a,bN0M0): A Review of the Literature

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.8035 ◽

2006 ◽

Vol 24 (13) ◽

pp. 2113-2122 ◽

Cited By ~ 77

Author(s):

Emer O. Hanrahan ◽

Vicente Valero ◽

Ana M. Gonzalez-Angulo ◽

Gabriel N. Hortobagyi

Keyword(s):

Breast Cancer ◽

Prognostic Factors ◽

Systemic Therapy ◽

Prognostic Significance ◽

Adjuvant Systemic Therapy ◽

Locoregional Therapy ◽

Breast Cancers ◽

Review Of The Literature ◽

Node Negative ◽

Current Guidelines

Purpose Mammographic screening has led to an increase in the number of small, node-negative breast cancers being diagnosed. Node-negative breast cancers that are ≤ 1 cm are stage T1a,bN0M0. Controversy surrounds the prognosis of these patients with locoregional therapy only and the need for adjuvant systemic therapy. Methods We performed a comprehensive review of the literature describing outcome and prognostic factors in stage T1a,bN0M0 breast cancer. We also reviewed current guidelines for systemic therapy in these patients. Results Early studies reported 10-year relapse-free survival (RFS) rates higher than 90% without adjuvant systemic therapy, but some more recent data suggest inferior outcomes. High tumor grade is the most consistent factor associated with poor prognosis. Other adverse prognostic factors are younger age, lymphovascular invasion (LVI), high Ki-67, and larger tumors within the T1a,b subgroup. Patients with high-grade tumors and/or LVI may have 10-year RFS rates of less than 75% in the absence of systemic therapy. The prognostic significance of hormone receptor status is unclear. Current guidelines for the systemic management of early-stage breast cancer differ when applied to stage T1a,bN0M0, reflecting the controversial nature of the issue. Conclusion Adjuvant systemic therapy is advisable for most patients with stage T1a,bN0M0 breast cancer who have grade 3 tumors and/or LVI. Other T1a,bN0M0 cases should be considered for systemic therapy based on clinicopathologic factors with known prognostic significance and assessment of the risk-benefit ratio. More reliable tools are needed to assess the prognosis of patients with stage T1a,bN0M0 breast cancer and their potential to benefit from specific therapeutic agents.

Download Full-text

Ten-Year Outcomes in a Population-Based Cohort of Node-Negative, Lymphatic, and Vascular Invasion–Negative Early Breast Cancers Without Adjuvant Systemic Therapies

Journal of Clinical Oncology ◽

10.1200/jco.2004.09.070 ◽

2004 ◽

Vol 22 (9) ◽

pp. 1630-1637 ◽

Cited By ~ 104

Author(s):

Stephen K. Chia ◽

Caroline H. Speers ◽

Cicely J. Bryce ◽

Malcolm M. Hayes ◽

Ivo A. Olivotto

Keyword(s):

Breast Cancer ◽

Systemic Therapy ◽

Population Based ◽

Adjuvant Systemic Therapy ◽

Breast Cancers ◽

Node Negative ◽

Breast Cancer Death ◽

Cancer Death Rate ◽

Breast Cancer Death Rate

Purpose To discuss the absolute benefits from adjuvant systemic therapy knowledge of long-term outcomes and baseline risks of relapse and disease-specific survival are required. We assessed the 10-year outcomes in a population-based cohort of node-negative (N−) lymphovascular negative (LV−) early breast cancers diagnosed from 1989 to 1991 who did not receive adjuvant systemic therapy. Methods One thousand one hundred eighty-seven cases of pT1–2N0 LV− breast cancers with a median follow-up of 10.4 years were reviewed. Kaplan-Meier survival curves for relapse free survival (RFS), breast cancer–specific survival (BCSS) and overall survival (OS) were compared with log-rank tests with cohorts stratified for tumor size and grade. Results The median age of this series was 62 years. Four hundred thirty tumors were ≤ 1 cm in diameter (cohort 1), 507 were 1.1–2 cm (cohort 2), and 250 were 2.1 to 5 cm in diameter (cohort 3). The 10-year outcomes for cohorts 1, 2, and 3, respectively, were significantly different: RFS, 82%, 75%, and 66%; BCSS, 92%, 90%, and 77%; and OS, 79%, 78%, and 66%. Tumor grade significantly altered outcome within size cohorts, particularly in pT1N0 breast cancers. Conclusion This study provides detailed information on the continued relapse and breast cancer death rate to 10 years of follow-up. Specifically, without adjuvant systemic therapy, patients with LV−, N − breast cancer had a ≥ 25% 10-year risk of relapse and a corresponding 10-year breast cancer death rate of ≥ 10% if they had either a grade 3 tumor ≤ 1 cm, a grade 2 to 3 tumor from 1.1 to 2 cm, or any grade tumor greater than 2 cm.

Download Full-text

Long-term survival after surgical treatment followed by adjuvant systemic therapy for primary duodenal melanoma

Clinical Journal of Gastroenterology ◽

10.1007/s12328-020-01112-9 ◽

2020 ◽

Vol 13 (4) ◽

pp. 532-537

Author(s):

Rodrigo Cañada Trofo Surjan ◽

Sergio do Prado Silveira ◽

Elizabeth Santana dos Santos ◽

Luciana Rodrigues de Meirelles

Keyword(s):

Surgical Treatment ◽

Systemic Therapy ◽

Adjuvant Systemic Therapy ◽

Term Survival ◽

Long Term Survival

Download Full-text

Influence of Race, Insurance, Socioeconomic Status, and Hospital Type on Receipt of Guideline-Concordant Adjuvant Systemic Therapy for Locoregional Breast Cancers

Journal of Clinical Oncology ◽

10.1200/jco.2011.36.8399 ◽

2012 ◽

Vol 30 (2) ◽

pp. 142-150 ◽

Cited By ~ 95

Author(s):

Xiao-Cheng Wu ◽

Mary Jo Lund ◽

Gretchen G. Kimmick ◽

Lisa C. Richardson ◽

Susan A. Sabatino ◽

...

Keyword(s):

Breast Cancer ◽

Hormonal Therapy ◽

Systemic Therapy ◽

Adjuvant Systemic Therapy ◽

Lymph Node Status ◽

Breast Cancers ◽

High Poverty ◽

Poverty Areas ◽

Patterns Of Care Study ◽

Modifiable Factors

For breast cancer, guidelines direct the delivery of adjuvant systemic therapy on the basis of lymph node status, histology, tumor size, grade, and hormonal receptor status. We explored how race/ethnicity, insurance, census tract-level poverty and education, and hospital Commission on Cancer (CoC) status were associated with the receipt of guideline-concordant adjuvant systemic therapy. Methods Locoregional breast cancers diagnosed in 2004 (n = 6,734) were from the National Program of Cancer Registries–funded seven-state Patterns of Care study of the Centers for Disease Control and Prevention. Predictors of guideline-concordant (receiving/not receiving) adjuvant systemic therapy, according to National Comprehensive Cancer Network Guidelines, were explored by logistic regression. Results Overall, 35% of women received nonguideline chemotherapy, 12% received nonguideline regimens, and 20% received nonguideline hormonal therapy. Significant predictors of nonguideline chemotherapy included Medicaid insurance (odds ratio [OR], 0.66; 95% CI, 0.50 to 0.86), high-poverty areas (OR, 0.77; 95% CI, 0.62 to 0.96), and treatment at non-CoC hospitals (OR, 0.69; 95% CI, 0.56 to 0.85), with adjustment for age, registry, and clinical variables. Predictors of nonguideline regimens among chemotherapy recipients included lack of insurance (OR, 0.47; 95% CI, 0.25 to 0.92), high-poverty areas (OR, 0.71; 95% CI, 0.51 to 0.97), and low-education areas (OR, 0.65; 95% CI, 0.48 to 0.89) after adjustment. Living in high-poverty areas (OR, 0.78; 95% CI, 0.64 to 0.96) and treatment at non-CoC hospitals (OR, 0.68; 95% CI, 0.55 to 0.83) predicted nonguideline hormonal therapy after adjustment. ORs for poverty, education, and insurance were attenuated in the full models. Conclusion Sociodemographic and hospital factors are associated with guideline-concordant use of systemic therapy for breast cancer. The identification of modifiable factors that lead to nonguideline treatment may reduce disparities in breast cancer survival.

Download Full-text