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Pathological complete response and survival after neoadjuvant chemotherapy in patients with stage I TNBC: a
M de Graaf1, R C A M Gielen1, S Balduzzi2
1Department of Tumor Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Background:
Pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) is a strong prognostic factor in patients with early-stage triple-negative breast cancer (TNBC). One-third of all patients with early-stage TNBC have stage I disease. Chemotherapy is recommended for most patients with stage I TNBC with an increasing use in the neoadjuvant setting supported by recent guidelines. However, little is known on the chemotherapy benefit for stage I TNBC, in particular the likelihood of a pCR and the prognostic value of pCR in this setting.
Patients And Methods:
Patients with cT1N0M0 TNBC who received standard of care NACT followed by surgery between 2012 and 2022 were identified from the Netherlands Cancer Registry. Baseline factors associated with pCR (ypT0/is, ypN0) and the impact of pCR on overall survival (OS) were evaluated.
Results:
A total of 1144 patients treated with anthracycline-taxane-based NACT were identified. Most patients had cT1N0 disease [n = 1077 (94%)] of no special subtype [n = 1034 (90%)]. In total, 656 patients (57.3%) had a pCR. Younger age [odds ratio (OR) 1.78, 95% confidence interval (CI) 1.38-2.30], higher tumor grade [OR 2.11, 95% CI 1.58-2.81] and smaller tumors [OR 2.03, 95% CI 1.15-3.69] were significantly associated with a higher likelihood of pCR, while patients with a lobular carcinoma were less likely to have a pCR (OR 0.17, 95% CI 0.03-0.67). Platinum-based treatment did not significantly improve the pCR rate (P = 0.9). pCR was associated with a better OS [adjusted hazard ratio (aHR) 0.23, 95% CI 0.11-0.45], with a 5-year OS of 97% versus 90% for patients with and without a pCR, respectively. Of 488 patients with residual disease, 280 (57.4%) received adjuvant capecitabine, which was not significantly associated with improved OS [aHR 0.65, 95% CI 0.30-1.44].
Conclusions:
Data from this real-world nationwide Dutch registry on neoadjuvant chemotherapy for stage I TNBC, with the majority of patients having cT1cN0 disease of no special subtype, suggests pCR to be associated with a favorable long-term outcome.
