1. Neoadjuvant chemotherapy in triple-negative breast cancer: A multicentric retrospective observational study in real-life setting
- Author
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Patrizia Vici, Nicola Tinari, Alessandra Cassano, Giuseppe Sanguineti, Luigi Di Lauro, Michele De Tursi, Antonio Astone, A. Vaccaro, Maddalena Barba, Andrea Michelotti, Laura Iezzi, Luisa Carbognin, Gennaro Ciliberto, Laura Pizzuti, Antonino Grassadonia, Antonio Giordano, Paolo Marchetti, Paola Fuso, Francesca Conti, E. Landucci, Clara Natoli, Marcello Maugeri-Saccà, Teresa Gamucci, Gianni Iafrate, Lucia Mentuccia, Domenico Sergi, Luca Moscetti, Isabella Sperduti, Emanuela Magnolfi, and Andrea Botticelli
- Subjects
0301 basic medicine ,Oncology ,Time Factors ,Multivariate analysis ,Physiology ,medicine.medical_treatment ,Clinical Biochemistry ,Triple Negative Breast Neoplasms ,Kaplan-Meier Estimate ,0302 clinical medicine ,Risk Factors ,Antineoplastic Combined Chemotherapy Protocols ,Odds Ratio ,Anthracyclines ,Adjuvant ,Neoadjuvant therapy ,Triple-negative breast cancer ,Univariate analysis ,Middle Aged ,Neoadjuvant Therapy ,Treatment Outcome ,Italy ,Chemotherapy, Adjuvant ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,rKi-67 ,Disease Progression ,triple-negative breast cancer ,Female ,Taxoids ,long-term outcomes ,neoadjuvant chemotherapy ,Adult ,medicine.medical_specialty ,pathological complete response ,Aged ,Chi-Square Distribution ,Disease-Free Survival ,Humans ,Ki-67 Antigen ,Multivariate Analysis ,Neoplasm Grading ,Proportional Hazards Models ,Retrospective Studies ,Cell Biology ,03 medical and health sciences ,Breast cancer ,Internal medicine ,medicine ,Chemotherapy ,Settore MED/06 - ONCOLOGIA MEDICA ,Proportional hazards model ,business.industry ,Retrospective cohort study ,medicine.disease ,030104 developmental biology ,Concomitant ,business - Abstract
We aimed to assess the efficacy of neoadjuvant chemotherapy (NACT) in a cohort of 213 triple-negative breast cancer (TNBC) patients treated in real-world practice at eight Italian cancer centers. We computed descriptive statistics for all the variable of interest. Factors testing significant in univariate analysis were included in multivariate models. Survival data were compared by Kaplan-Meier curves and log-rank test. The median follow-up was 45 months. We observed 60 (28.2%) pathological complete response (pCR). The sequential anthracyclines-taxanes-based regimens produced the highest rate of pCR (42.6%), followed by concomitant anthracycline-taxane (24.2%), and other regimens (15.6%) (p = 0.008). When analyzing the role of baseline Ki-67, a 50% cut-off was the optimal threshold value for pCR prediction (p = 0.0005). The 5-year disease-free survival (DFS) was 57.3% and the 5-year overall survival (OS) was 70.8%. In patients not achieving pCR, the optimal Ki-67 variation between biopsy and surgical specimen with prognostic relevance on long-term outcomes was 13% (p = 0.04). Patients with a Ki-67 reduction (rKi-67)13% had worse outcomes compared to those who experienced pCR or a rKi-67≥13%. The number of NACT cycles also affected long-term outcomes (5-year DFS 65.7% vs 51.6% in patients having received6 cycles compared with their counterparts, p = 0.02). In multivariate analysis, node status, grading, and bio-pathological treatment response (including pCR and rKi-67) impacted DFS and OS. Our results confirmed the advantage conferred by more than 6 cycles of a sequential antracycline-taxane-based NACT. Higher baseline Ki-67 values shows greater predictive significance on pathogical response, while the rKi-67 plays a prognostic role on long-term outcomes.
- Published
- 2017