% of TNBC recurrence

brena

% of TNBC recurrence

brena

Ladies,

Has any come across statistics that show what % of us TN that get  a recurrence or distant metastases? if so, please provide a link or any data that you can recall. I do understand there are many variables that contribute to both; stage, age, tumor size, node status etc. but I am hoping to find some real data that supports allot of the information that we are given. I find conflicting data and none to support my question below.

I do know the 5 year overall survival of 77-85% for TN but this is not what I am seeking.

Of the 100% of women diagnosed with TN how many actually get a recurrence or distant metastases? and what are those women biomarkers and outcome?

thanks,

ekenny315

Great question Brena, I'm curious myself - Hope we can get some answers

HollyHopes

me too...

Gorilla12

Here is a site with some stats - very positive!

http://bcwatchdigest.evidencewatch.com/

brena

Gorilla12,

Thanks for the link, much information given but could not find the numbers I am seeking. Regardless, it does not answer my question, of the so given 15% of TNBC woman diagnosed yearly "how many get a recurrence?" I have read many articles from different reliable resources and it appears there is no answer because data has not been collected, makes me wonder.

May be someone's Onc can answer the question and cite the source of the given data? Let me know if you can get an answer. I do know that TN will be the topic of discussion on July 16 with ask the expert at breastcancer.org.

thanks for you reply and the data,

Traci-----TripNeg

Brena, thanks for telling me that that will be the topic of conversation for the experts. I will definitely be attending that one.

Everything I've read just gets me scared and mad. I do not Google TNBC anymore.

Hugs, Traci

Edited to add: My oncologist didn't tell me anything. I thought triple negative was a good thing when I left his office. I found out on this site that it was rare.

jason222

 Hi there,

This is the closest stat I can find regarding recurrence and survival rates. Not sure how accurate is this though. Hope it helps.

http://www.asco.org/ASCO/Abstracts+&+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=55&abstractID=34542

liven42day

I would like to know the recurrence/survival rates also. I have  a couple of friends in our local BC group, 2 of them had masts, chemo, rads and are 10 years out, 1 is 5 years out with double mast and rads, the other lady passed away 7 months ago, but was dx at stage 4 with mets already. Our group has about 25 people in it and 5 of us are trip neg. I am 1 year out now. Take Care Ladies

brena

Ladies,

Thanks Jason222 for direction, asco is a reliable data source. 

Found some recent data with current statistics, will copy data and link into separate sections:

http://www.asco.org/ASCO/Abstracts+&+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=47&abstractID=35905#

Differential response to primary chemotherapy and long-term survival in patients with triple-negative breast cancer.

Objective. Triple-negative breast cancer is defined as a subtype of invasive breast cancer which lacks estrogen and progesterone receptor expression as well as HER2/neu expression and is highly similar to the basal-like subtype defined by gene expression profiling. Method. 1,143 patients treated at MD Anderson Cancer Center in neoadjuvant trials were included in a retrospective comparative analysis between triple-negative tumors and non-triple-negative tumors for response to neoadjuvant chemotherapy as well as long- term survival. Results. 827/1,143 (72%) patients had received taxanes, either as a single-agent (n=60) or in combination with anthracycline (n=767), whereas the remainder patients received an anthracycline-only chemotherapy. Overall 258/1,143 (23%) tumors were triple- negative. Complete pathological response (pCR) was achieved in 63/257 (25%) patients with triple-negative tumors compared to 99/888 (11%) in patients with non-triple-negative tumors (odds ratio [OR] 1.14, 95%CI: 1.09-1.20, p=.0082). Triple-negative status correlated significantly with high nuclear grade (p<.0001), whereas no significant correlation with any established clinicopathologic parameter was observed. However, 5-year overall survival (5yrOS) was 66% in the triple-negative group compared to 83% in the non-triple-negative control group (OR 2.1, 95%CI: 1.6-2.8, p<.0001). In multivariate analyses, triple-negative status (hazard ratio [HR] 2.0, 95%CI: 1.4-2.8, p<.0001), high nuclear grade, increased tumor size (HR 1.5, 95%CI: 1.3-1.8, p<.0001), positive nodal status (HR 1.4, 95%CI: 1.2-1.7, p=.0002) and high nuclear grade (HR 1.7, 95%CI: 1.1- 2.4, p=.0089) were significantly associated with decreased 5yrOS. When survival was analyzed according to both response rate and triple negative status, achievement of pCR was a stronger predictor of survival compared to triple-negative status.

Conclusion. Triple- negative expression status among patients with breast cancer constitutes an independent unfavorable prognostic factor with regards to overall survival unless achieving pCR after neoadjuvant chemotherapy.

brena

Ladies,

More data: it appears this study supports TNBC is aggressive as has been reported. This study shows data from TNBC to other early-stage breast cancer.

Time to recurrence and survival in triple negative early-stage breast cancer.

http://www.asco.org/ASCO/Abstracts+%26+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=47&abstractID=36280

Background:Breast cancer (BC) is the most common neoplasm among Mexican women. Clinical, tumoral and biologic factors have proven useful in predicting prognosis regarding recurrence and survival. Triple negative (TN) phenotype (ER, PR and HER2 negative) has been reported to be associated with more aggressive clinical behavior. Objective: To compare clinical, tumor, biologic characteristics of TN time to recurrence and survival to other phenotypes in early BC. Methods:Records of women with stage I - II BC evaluated from Jan. 2000 to June 2006 were reviewed. ER/PR+: > 10 fmol/pgr and HER2+, 3+ by immunohistochemistry or FISH > 2.2 were considered. Five groups were designed: 1) TN, 2) triple positive, 3) HER2-/ER/PR+, 4) HER2+/ER/PR-, 5) HER2-/ one hormonal receptor (HR) +. ANOVA, Chi-2 and Kruskal-Wallis tests were applied for the statistical analysis. Results:110 patients were included (17, 14, 52, 11, 16 respectively). Median age (43, 49.5, 55, 53 51 yrs); clinical stage; tumor size, axillary lymph node status and angiogenesis score were similar in all groups, p > 0.05. Median Ki67 was higher in TN group (47.5, 20, 20, 42.5, 10, p< 0.000). Proportion of patients with conservative surgery was similar, p= 0.308. Fourteen recurrences were observed, 2 local and 12 systemic (3, 1, 3, 5, 2 in each group). Median time to recurrence (6, 54, 30, 20, 27 mos); there were 7 deaths due to tumor. Number of deaths was higher in TN and HER+/HR- (17.4, 7.1, 0, 18.1, 6.2%).   Conclusions:TN phenotype represents 15% in this early BC population and was associated to higher Ki67. There are premature signs (age, number of recurrences and deaths) that suggest a poor prognosis for TN patients, similar to those with HER2+/ERPR-.

brena

Ladies,

More interesting BC data comparing 3- to 3+: Data collected 2002-2004 but reported in 2007, it takes data that long to be collected and reported.

Triple-negative breast cancer. A clinicopathologic study of 113 cases and comparison with 55 cases with triple positive breast cancer: A matched-control analysis.

http://www.asco.org/ASCO/Abstracts+&+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=47&abstractID=30394

Abstract:

Background: Hormone receptor negative breast cancer (BC) is associated with poor outcome. BC patients (pts) with HER2/neu over expression (IHC 3+) are associated as well with poor prognosis. Aim: to further divide breast cancer to prognostic subgroups using interaction between these 2 prognostic factors. Methods: Between January 2002 and May 2004, the clincopathological features as well as treatment results of all non metastatic pts with triple negative BC (TNBC) and those with triple positive BC (TPBC) were reviewed. In all patients the three immunohistochemical markers, ER, PR and HER2/neu were available for review. Results: 113 TNBC pts and 55 TPBC were identified. In the TNBC group; median age was 42y, 76 % were premenopause, 21% with + family history (FH) and 6% were pregnant at diagnosis. Clinical stage (CS): I: 4%, II: 60%, III: 36%. Neo-adjuvant chemotherapy (NACT) was given to 29 %. Modified radical mastectomy (MRM) and breast conservative surgery (BCS) were performed in 49% and 51% respectively. Adjuvant CT (ACT) and radiotherapy (RT) were given to 85% and 84% of the pts. In the TPBC group, the median age was 43y, 71% were premenopause, 16% with + FH, and 2% were pregnant. The CS in the TPBC group was I: 4%, II: 65%, III: 31%. The distributions of NACT, MRM, BCS, ACT and RT in TPBC pts were 35%, 64%, 36%, 60% and 84% respectively. All TPBC pts received adjuvant hormonal therapy and non received adjuvant Herceptin. Relapse rate was 34% in TNBC and 20 % in TPBC (p = 0.04). At a median follow up of 40 months, 72% and 80% of the pts in the TNBC and TPBC groups are alive and disease free respectively. The 4y EFS and OS were 64% and 76% in TNBC and 74% and 89% in TPBC group (p = 0.04 and 0.008 respectively).   Conclusions: TNBC is an aggressive neoplasm and has a poor outcome. More aggressive adjuvant chemotherapy and possible biological therapy directed against EGFR, based on previous released information of the prevalence of EGFR in this particular phenotype, should be considered in this group of patients.

brena

TN Ladies,

I am on a roll, something we already know but nice to see supporting data:

Triple-negative receptor status and prognosis in the NCIC CTG MA.21 adjuvant breast cancer trial.

http://www.asco.org/ASCO/Abstracts+&+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=55&abstractID=33209

Abstract:

Background: Triple-negative breast tumors which are negative for ER, PR, and HER2-neu receptors by immunohistochemistry are associated with a poor prognosis. The MA.21 trial compared 3 adjuvant chemotherapy regimens after surgery in pre- or early menopausal women 60 years or younger with breast cancer (Proceedings ASCO 2007, 25, 550). This analysis explored the outcome of the triple-negative subset of patients compared to nontriple negatives in the MA.21 trial with respect to relapse-free survival (RFS). Methods: Women with axillary node-positive or high-risk node-negative breast cancer were randomized to cyclophosphamide, epirubicin, 5FU (CEF), dose-dense epirubicin and cyclophosphamide plus filgrastim followed by paclitaxel (EC/T) or doxorubicin and cyclophosphamide followed by paclitaxel (AC/T), for six months. ER status was a known stratification factor for all patients. Median follow-up was 30.4 months with 261 recurrences. Characteristics of patients with and without knowledge of triple-negative status were compared with exact Fisher's tests. Step-wise multivariate Cox regressions were performed with forced inclusion of trial therapy and stratification factors. Additionally, RFS was determined from adjusted Cox survivor plots. Results: The trial enrolled 2,104 patients. ER, PR, and HER2 status based on local institutional results were known for 1,623; 551 patients had triple-negative tumors. After adjusting for treatment, stratification factors of lymph node status, surgery type, and age, highly significant differences in 3-year RFS were found when the triple-negative subgroup (RFS 80.5%) was compared to others where all PR and HER2-neu had known values (RFS 86.5%, p=0.0002), or not (RFS 87.7%, p< 0.0001). From multivariate analyses, triple-negative patients had significantly worse RFS (p< 0.0001). At this time, there are too few events to assess whether RFS differs by treatment arm for triple-negative patients. Conclusions: Pre- and postmenopausal women with triple-negative tumors had a reduced three-year relapse-free survival compared to women with nontriple-negative tumors. Supported by NCIC Canada and Canadian Cancer Society, Pfizer, Bristol-Myers Squibb, Amgen, Janssen Ortho, Ortho Biotech, and NCI US.

brena

TNBC Ladies,

Clinical outcome of triple-negative (TN) breast cancer (BC).

http://www.asco.org/ASCO/Abstracts+&+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=55&abstractID=34542

Abstract:

Background: Breast cancer is a heterogeneous disease with different biologic characteristics and clinical behaviors. Triple- negative tumors, most of which fall into the basal subgroup of breast cancers based on microarray profiling have been reported to have an aggressive clinical course. Methods: We reviewed the medical records of early breast cancer patients (pts) with known receptor and Her- 2 satus by immunohistochemistry, who have been treated in our institution between 1999-2006. We recorded the clinical/pathologic characteristics of these tumors, analyzed survival outcome. Results: We identified 60 pts with triple negative tumors among 705 early BC cases. 4% pts were <35 years of age, 58% were postmenopausal, 57% had left breast involved, 36% had breast-conserving surgery. The histology was invasive ductal carcinoma in 72% cases, invasive lobular in 8% and medullary in 8% cases. Thirty percent of pts had node- positive disease, 40%/53% had grade 2/3 tms respectively. Twenty percent of the pts had multifocal disease, 40% had lymphovascular invasion. Eighty percent of pts had anthracycline-based, 12% had anthracycline/taxane- based adjuvant chemotherapy. 51% had adjuvant radiotherapy. So far 5 pts had relapse and one patient died because of BC. Eight-year overall survival is 88% and 8-year disease-free survival (DFS) is 75%. Conclusions: Not all of these TN BC pts had poor prognostic features as mentioned in literature. Both the overall survival and DFS are almost similar to those with receptor negative subset in our institution. Effective treatment strategies can only be implemented with increased understanding of the biology of this distinct breast cancer subtype.