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Benefit of adjuvant chemotherapy in patients with special histology subtypes of triple-negative breast cancer: a systematic review

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Abstract

Purpose

Breast cancer (BC) is a leading cause of morbidity, disability, and mortality in women, worldwide; triple-negative BC (TNBC) is a subtype traditionally associated with poorer prognosis. TNBC special histology subtypes present distinct clinical and molecular features and sensitivity to antineoplastic treatments. However, no consensus has been defined on the best adjuvant therapy. The aim of the review is to study the evidence from literature to inform the choice of adjuvant treatments in this setting.

Methods

We systematically searched literature assessing the benefit of adjuvant chemotherapy in patients with TNBC special histotypes (PROSPERO: CRD42020153818).

Results

We screened 6404 records (15 included). All the studies estimated the benefit of different chemotherapy regimens, in retrospective cohorts (median size: 69 patients (range min–max: 17–5142); median follow-up: 51 months (range: 21–268); mostly in Europe and USA). In patients with early-stage adenoid cystic TNBC, a marginal role of chemotherapy was reported. Similar for apocrine TNBC. Medullary tumors exhibited an intrinsic good prognosis with a limited role of chemotherapy, suggested to be modulated by the presence of tumor-infiltrating lymphocytes. A significant impact of chemotherapy on the overall survival was estimated in patients with metaplastic TNBC. Limitations were related to the retrospective design of all the studies and heterogeneous treatments received by the patients.

Conclusions

There is potential opportunity to consider treatment de-escalation and less intense therapies in some patients with early, special histology-type TNBC. International efforts are indispensable to validate prospective clinical decision models.

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Abbreviations

BC:

Breast Cancer

DFS:

Disease-Free Survival

HER2:

Human Epidermal Growth Factor Receptor 2

HR:

Hormone Receptor

NOS:

Not Otherwise Specified

NST:

No Special Type

OS:

Overall Survival

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

TILs:

Tumor-Infiltrating Lymphocytes

TNBC:

Triple-Negative Breast Cancer

WHO:

World Health Organization

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Funding

This work was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5 × 1000 funds.

Author information

Author notes

  1. F. Giugliano, J. Uliano and V.A. Zia have equally contributed to this work.

Authors and Affiliations

  1. Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy

    D. Trapani, F. Giugliano, J. Uliano, A. Marra, G. Viale, E. Ferraro, A. Esposito, C. Criscitiello, P. D’amico & G. Curigliano

  2. Department of Oncology and Hematology (DIPO), University of Milan “La Statale”, Via Festa Del Perdono 1, 20122, Milan, Italy

    F. Giugliano, J. Uliano, A. Marra, E. Ferraro, C. Criscitiello, P. D’amico & G. Curigliano

  3. Division of Medical Oncology, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04037-004, Brazil

    V. A. A. Zia

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  1. D. Trapani
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Contributions

Conceptualization (GC), Data curation (FG, JU, VZ, DT, GC), Formal Analysis (GC, DT), Investigation (DT, FG, JU, VZ, GC), Methodology (VZ, EF, DT, AM, GV, PD, CC, GC), Project administration (GC), Resources (GC, DT), Supervision (GC), Validation (DT, GC), Visualization (FG, JU, EF), Writing—original draft (all the authors), Writing—review & editing of the final draft (all the authors).

Corresponding author

Correspondence to G. Curigliano.

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GF, UJ, AM, EF, GV, DT, PD, EA declare no potential COI. GC has received honoraria from Pfizer, Novartis, Lilly, Roche; fees for expert testimony and medical education from Pfizer; and has participated in advisory board s for Pfizer, Roche, Lilly, Novartis, Seattle Genetics, Celltrion. All the declarations are outside the submitted work. CC, received honoraria for speaker bureau, consultancy or advisory role from Roche, Novartis, Pfizer, Eli-Lilly, and MSD. VAAZ is also employee from Takeda Oncology. No COI in this submitted work.

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Trapani, D., Giugliano, F., Uliano, J. et al. Benefit of adjuvant chemotherapy in patients with special histology subtypes of triple-negative breast cancer: a systematic review. Breast Cancer Res Treat 187, 323–337 (2021). https://doi.org/10.1007/s10549-021-06259-8

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