Tumor-Infiltrating Lymphocytes in Patients With Stage I Triple-Negative Breast Cancer Untreated With Chemotherapy

Veerle C M Geurts ¹, Sara Balduzzi ², Tessa G Steenbruggen ^3,4

¹Division of Tumor Biology and Immunology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
²Department of Biometrics, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
³Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
⁴Department of Internal Medicine, St Antonius Hospital, Nieuwegein, the Netherlands.
⁵Department of Pathology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
⁶Division of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands.
⁷Department of Research and Development, the Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands.
⁸Department of Health, Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands.
⁹Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia.
¹⁰Winship Cancer Institute, Emory University, Atlanta, Georgia.
¹¹Department of Medicine, University of Pennsylvania, Philadelphia.
¹²Department of Medical Oncology, Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium.
¹³Department of Oncology, Mayo Clinic, Rochester, Minnesota.
¹⁴Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
¹⁵Perlmutter Cancer Center, New York University, New York.
¹⁶Grossman School of Medicine, New York University, New York.
¹⁷Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Inserm, Paris-Saclay University, labeled Ligue Contre le Cancer, Villejuif, France.
¹⁸Division of Cancer Research, Peter Mac Callum Cancer Center, Melbourne, Victoria, Australia.
¹⁹The Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, Parkville, Australia.
²⁰Department of Pathology, Ziekenhuis aan de Stroom (ZAS), Antwerp, Belgium.
²¹Division of Research, Peter Mac Callum Cancer Center, Melbourne, Victoria, Australia.

⁰Division of Tumor Biology and Immunology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.

Jama Oncology +

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June 27, 2024

View abstract on PubMed

Summary

High stromal tumor-infiltrating lymphocytes (sTILs) in stage I triple-negative breast cancer (TNBC) indicate excellent survival outcomes without chemotherapy. These findings support sTILs as biomarkers for treatment selection in TNBC patients.

Area Of Science

Oncology
Immunology
Pathology

Background

The benefit of chemotherapy in stage I triple-negative breast cancer (TNBC) is uncertain, lacking biomarkers to identify patients with favorable prognoses.
High stromal tumor-infiltrating lymphocytes (sTILs) correlate with better survival in TNBC, but data specific to stage I are limited.

Purpose Of The Study

To evaluate the outcomes of patients with stage I TNBC who did not receive chemotherapy, stratified by stromal tumor-infiltrating lymphocyte (sTIL) levels.
To determine the prognostic value of sTILs in stage I TNBC for breast cancer-specific survival (BCSS).

Main Methods

A cohort study analyzed data from the Netherlands Cancer Registry (2005-2015) for stage I TNBC patients not treated with chemotherapy.
sTIL levels were centrally reviewed in 1041 patients using International Immuno-Oncology Biomarker Working Group guidelines.
Breast cancer-specific survival (BCSS) was assessed at 5, 10, and 15 years for sTIL cutoffs of 30%, 50%, and 75%.

Main Results

Patients with high sTIL levels (≥30%) demonstrated significantly better BCSS compared to those with low sTIL levels (<30%) (96% vs 87% at 10 years).
In patients with pT1c tumors, high sTIL levels (≥50%) were associated with improved outcomes compared to lower levels (HR, 0.27).
Excellent 10-year BCSS rates were observed in patients with stage I TNBC and high sTIL levels who did not receive chemotherapy.

Conclusions

High sTIL levels are associated with excellent breast cancer-specific survival in stage I triple-negative breast cancer patients not receiving chemotherapy.
Stromal tumor-infiltrating lymphocytes (sTILs) are valuable biomarkers for optimizing therapy selection in stage I TNBC within clinical trials.

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