Skip to main content

Advertisement

Log in

Adjuvant versus neoadjuvant chemotherapy in triple-negative breast cancer patients with BRCA mutations

Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

As triple-negative breast cancers are associated with earlier recurrences and poorer survival, optimal treatment of early-stage breast cancer is essential. Several retrospective studies in triple-negative breast cancer have reported conflicting results in overall survival in patients receiving neoadjuvant or adjuvant systemic therapy. This study aims to analyze outcomes of adjuvant versus neoadjuvant in patients with early-stage triple-negative breast cancer with and without BRCA germline mutations.

Methods

Patients with stage I or II triple-negative breast cancer who had BRCA testing were identified from a prospective cohort study of 4027 patients. Clinical, demographic, genetic test results, chemotherapy, recurrence, and survival data were analyzed. Overall survival and disease-free survival were estimated using the Kaplan–Meier method.

Results

319 patients with stage I and II triple-negative breast cancer who met eligibility criteria were included in the analysis. 187 received adjuvant chemotherapy (58.6%) and 132 received neoadjuvant chemotherapy (41.4%). 135 were BRCA positive (42.3%) and 184 were BRCA negative (57.7%). There was no significant association between overall survival or disease-free survival and treatment with neoadjuvant versus adjuvant in the overall cohort. Furthermore, there were no significant differences between patient subgroups (neoadjuvant BRCA positive, neoadjuvant BRCA negative, adjuvant BRCA positive, and adjuvant BRCA negative) with respect to either overall survival or disease-free survival.

Conclusions

Neoadjuvant versus adjuvant with standard anthracycline- and taxane-containing regimens results in similar disease-free survival and overall survival among patients with stage I and II triple-negative breast cancer regardless of BRCA status. Further studies are needed to evaluate whether similar results are observed with newer agents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. American Cancer Society (2017) Cancer Facts & Figures 2017 Supplemental Data. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf. Accessed 4 Dec 2017

  2. Stover D, Bell CF, Tolaney SM (2016) Neoadjuvant and adjuvant chemotherapy considerations for triple negative breast cancer. Am J Hematol Oncol 12(3):6–12

    Google Scholar 

  3. Hartman AR, Kaldate RR, Sailer LM et al (2012) Prevalence of BRCA mutations in an unselected population of triple-negative breast cancer. Cancer 118:2787–2795

    Article  PubMed  CAS  Google Scholar 

  4. Meyer P, Landgraf K, Hogel B et al (2012) BRCA2 mutations and triple-negative breast cancer. PLoS ONE 7(5):e38361. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0038361. Accessed 26 Sept 2017

  5. Sharma P, Klemp JR, Kimler BF et al (2014) Germline BRCA mutation evaluation in a prospective triple-negative breast cancer registry: implications for hereditary breast and/or ovarian cancer syndrome testing. Breast Cancer Res Treat 145:707–714

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Greenup R, Buchanan A, Lorizio W et al (2013) Prevalence of BRCA mutations among women with triple-negative breast cancer (TNBC) in a genetic counseling cohort. Ann Surg Oncol 20:3254–3258

    Article  PubMed  Google Scholar 

  7. Kwon JS, Gutierrez-Barrera AM, Young D et al (2010) Expanding the criteria for BRCA mutation testing in breast cancer survivors. J Clin Oncol 28:4214–4220

    Article  PubMed  Google Scholar 

  8. Wolmark N, Wang J, Mamounas E et al (2001) Preoperative chemotherapy in patients with operable breast cancer: nine-year results from national surgical adjuvant breast and bowel project B-18. Monogr Natl Cancer Inst 30:96–102

    Article  Google Scholar 

  9. Rastogi P, Anderson SJ, Bear HD et al (2008) Preoperative chemotherapy: updates of national surgical adjuvant breast and bowel project protocols B-18 and B-27. J Clin Oncol 26:778–785

    Article  PubMed  Google Scholar 

  10. Kennedy CR, Gao F, Margenthaler JA (2010) Neoadjuvant versus Adjuvant chemotherapy for triple negative breast cancer. J Surg Res 163(1):52–57

    Article  PubMed  CAS  Google Scholar 

  11. Fisher CS, Ma CX, Gillanders WE et al (2011) Neoadjuvant chemotherapy is associated with improved survival compared with adjuvant chemotherapy in patients with triple-negative breast cancer only after complete pathologic response. Ann Surg Oncol 19(1):253–258

    Article  PubMed  PubMed Central  Google Scholar 

  12. Edge SB, Byrd DR, Compton CC et al (2010) AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  13. Somlo G, Frankel PH, Arun BK et al (2017) Efficacy of the PARP inhibitor veliparib with carboplatin or as a single agent in patients with germline BRCA1- or BRCA2-associated metastatic breast cancer: California cancer consortium trial NCT01149083. Clin Cancer Res 23(15):4066–4076

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  14. Tutt A, Robson M, Garber JE et al (2010) Oral poly(ADP-ribose) polymerase inhibitor olaparib in patients with BRCA1 or BRCA2 mutations and advanced breast cancer: a proof-of-concept trial. Lancet 376(9737):235–244

    Article  PubMed  CAS  Google Scholar 

  15. Robson M, Im SA, Senkus E et al (2017) Olaparib for metastatic breast cancer in patients with a germline BRCA mutation. N Engl J Med 377:523–533

    Article  PubMed  CAS  Google Scholar 

  16. Isakoff SJ, Puhalla S, Domchek SM et al (2017) A randomized phase II study of veliparib with temozolomide or carboplatin/paclitaxel versus placebo with carboplatin/paclitaxel in BRCA1/2 metastatic breast cancer: design and rationale. Future Oncol 13(4):307–320

    Article  PubMed  CAS  Google Scholar 

  17. Miller K, Tong Y, Jones D et al (2015) Cisplatin with or without rucaparib after preoperative chemotherapy in patients with triple negative breast cancer: final efficacy results of Hoosier Oncology Group BRE09-146. J Clin Oncol 33(15 suppl):1082

    Google Scholar 

  18. Rugo HS, Olopade OI, DeMichele A et al (2016) Adaptive randomization of veliparib-carboplatin treatment in breast cancer. N Engl J Med 375(1):23–34

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Tutt A, The TNT trial. Presented at 2014 San Antonio Breast Cancer Symposium, Dec 2014, San Antonio, TX

  20. Byrski T, Huzarski T, Dent R et al (2014) Pathologic complete response to neoadjuvant cisplatin in BRCA1-positive breast cancer patients. Breast Cancer Res Treat 147(2):401–405

    Article  PubMed  CAS  Google Scholar 

  21. Hahnen E, Lederer B, Hauke J et al (2017) Germline mutation status, pathological complete response, and disease-free survival in triple-negative breast cancer. JAMA Oncol. https://doi.org/10.1001/jamaoncol.2017.1007

    Article  PubMed  Google Scholar 

  22. Arun B, Bayraktar S, Liu DD et al (2011) Response to neoadjuvant systemic therapy for breast cancer in BRCA mutation carriers and noncarriers: a single-institution experience. J Clin Oncol 29(28):3739–3746

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. O’Keefe DJ (2007) Brief report: post hoc power, observed power, a priori power, retrospective power, prospective power, achieved power: sorting out appropriate uses of statistical power analyses. Commun Methods Meas 1(4):291–299

    Article  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge that this work was funded by the IBC foundation and the Andrew and Lillian A. Posey Foundation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Katherine Clifton.

Ethics declarations

Conflicts of interest

Dr. Jennifer Litton reports contracted research from Pfizer, Novartis, EMD-Serono, AstraZeneca, GlaxoSmithKline, and Genentech. Advisory Boards for Astra Zeneca and Pfizer, both uncompensated. The remaining authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Clifton, K., Gutierrez-Barrera, A., Ma, J. et al. Adjuvant versus neoadjuvant chemotherapy in triple-negative breast cancer patients with BRCA mutations. Breast Cancer Res Treat 170, 101–109 (2018). https://doi.org/10.1007/s10549-018-4727-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-018-4727-9

Keywords

Navigation