TITLE:
Pattern of Failure and Treatment Results in Triple Negative Breast Cancer Patients
AUTHORS:
Sherif Zawawy, Gehan Khedr
KEYWORDS:
Metastatic Breast Cancer, Triple Negative, Pattern of Failure
JOURNAL NAME:
Advances in Breast Cancer Research,
Vol.11 No.2,
February
18,
2022
ABSTRACT: Background: Triple negative breast cancer (TNBC) tends to present aggressively with
rapid progression and poor survival. Methods: We retrospectively
reviewed patients’ files to define TNBC patients’ characteristics, predictive
and prognostic factors, pattern of recurrence and survival. Results: 965
cases were identified. 147 patients (15.2%) were TNBC. 71.1% patients were
premenopausal. T2, T3, T4 tumors represented 46.1%, 32% and 14.1%,
respectively. N0, N1, N2, N3 disease represented 18.5%, 50.9%, 27.8% and 2.8%,
respectively. Stages II, III & IV
constituted 34.1%, 44.2% and 15.5%, respectively. 31.5% patients received
neoadjuvant chemotherapy with 17.7% complete pathological response. 19.5%,
35.9%, 44.6% patients had unknown, ≤20 and >20 Ki67, respectively. Among non-metastatic patients (n = 108), 21.3% patients developed relapse with
median time to relapse of 11 months. 78.3% of them had visceral (88.3% lung)
metastasis, 13% bone metastasis, 21.7% brain metastasis and 13% LRR. There is significantly high risk of relapse in patients with large tumor size [T4:
66.75%, T3: 22.9%, T2: 16.7%, T1: 0% (p = 0.002)], positive LNs [N3: 100%, N2: 37.9%, N1: 15.1%,
N0: 4.3% (p 0.001)] and Ki67 [>20: 31.6% versus 10.8% for Ki67 ≤ 20 (P = 0.007)].
Multivariate analysis revealed only T4 and N2-3 were significantly associated
with high probability for relapse (P = 0.022 & 0.038). The 3-year DFS
and OS were 73.2% and 75% respectively. For metastatic patients (n = 20), the m
PFS was 7 months and m OS 1.5 years. Conclusion: Our data confirms the
aggressive nature of TNBC with significant risk of relapse for patients with
large tumor and positive lymph nodes. Maintenance metronomic capecitabine,
neoadjuvant/adjuvant immunotherapy could be beneficial for non-metastatic patients.
Lungs and brain were the most common sites of distant failure with poor
survival that necessitates administration of molecular biomarkers (BRCA
mutations, PD-L1 expression and microsatellite instability) for patients’ selection for
novel targeted therapy.