EXPERT ANALYSIS FROM SABCS 2014
SAN ANTONIO (FRONTLINE MEDICAL NEWS) – Patients with stage T1a or T1b triple-negative breast cancer have an excellent prognosis even without chemotherapy, according to Dr. Eric P. Winer.
“There’s a perception on the part of many patients and physicians that all triple-negative breast cancer is bad, and that it’s destined to threaten and ultimately take a woman’s life. But even in an era where biology is king, stage still matters,” he observed at the San Antonio Breast Cancer Symposium.
He was a coinvestigator in a recent prospective cohort study which included 4,113 women with stage T1a or 1b breast cancer – that is, a tumor size no greater than 10 mm in its greatest dimension – without regional lymph node metastases or evidence of distant metastases. The patients, drawn from the National Comprehensive Cancer Network database, were treated in accord with institutional practice and followed for a median of 5.5 years.
Slightly over half of those in the subset with triple-negative breast cancer (TNBC) got chemotherapy. Those who received chemotherapy for T1a TNBC as defined by a tumor size not greater than 5 mm had a 5-year distant relapse-free survival (DRFS) of 100%, but the rate was still close to 95% in those not treated with chemotherapy. Outcomes were also quite favorable for patients with T1b TNBC who didn’t receive chemotherapy ( J. Clin. Oncol. 2014;32:2142-50 ), said Dr. Winer, chief of the division of women’s cancers at the Dana-Farber Cancer Institute and professor of medicine at Harvard Medical School, Boston.
He noted that the findings in this study echo those of an earlier study by investigators at University of Texas M.D. Anderson Cancer Center, Houston, who reported a 5-year DRFS rate of 96% in 125 patients with T1a or 1b, lymph node-negative TNBC untreated with chemotherapy (J. Clin. Oncol. 2009;27:5700-6).
Dr. Winer said that while the consensus among most experts is that standard adjuvant chemotherapy regimens for patients with stage 2 or 3 TNBC include both anthracyclines and taxanes, his own view is that for patients with stage 1 TNBC “if you’re going to pursue chemotherapy, then treatment with a somewhat less toxic, shorter regimen would seem to be more appropriate.”