Response to Neoadjuvant Therapy and Long-Term Survival in Patients With Triple-Negative Breast Cancer

PURPOSETriple-negative breast cancer (TNBC) is defined by the lack of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) expression. In this study, we compared response to neoadjuvant chemotherapy and survival between patients with TNBC and non-TNBC.PATIENTS AND METHODSAnalysis of a prospectively collected clinical database was performed. We included 1,118 patients who received neoadjuvant chemotherapy at M.D. Anderson Cancer Center for stage I-III breast cancer from 1985 to 2004 and for whom complete receptor information were available. Clinical and pathologic parameters, pathologic complete response rates (pCR), survival measurements, and organ-specific relapse rates were compared between patients with TNBC and non-TNBC.RESULTSTwo hundred fifty-five patients (23%) had TNBC. Patients with TNBC compared with non-TNBC had significantly higher pCR rates (22% v 11%; P =.034), but decreased 3-year progression-free survival rates (P <.0001) and 3-year overall survival (OS) rates (P <.0001). TNBC was associated with increased risk for visceral metastases (P =.0005), lower risk for bone recurrence (P =.027), and shorter postrecurrence survival (P <.0001). Recurrence and death rates were higher for TNBC only in the first 3 years. If pCR was achieved, patients with TNBC and non-TNBC had similar survival (P =.24). In contrast, patients with residual disease (RD) had worse OS if they had TNBC compared with non-TNBC (P <.0001).CONCLUSIONPatients with TNBC have increased pCR rates compared with non-TNBC, and those with pCR have excellent survival. However, patients with RD after neoadjuvant chemotherapy have significantly worse survival if they have TNBC compared with non-TNBC, particularly in the first 3 years.