# Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer

Source: https://onco.cc/key-papers/paper-liedtke-neoadjuvant-response-survival-tnbc-jco-2008/  
OnCo record `paper-liedtke-neoadjuvant-response-survival-tnbc-jco-2008` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2008 MD Anderson series of 1,118 women that defined the triple-negative paradox: these tumours disappear completely with pre-surgery chemotherapy twice as often as other breast cancers, yet survival is worse, because the women left with residual disease relapse early and often.

## Summary

Liedtke, Mazouni, Hess, André and colleagues analysed 1,118 patients treated with neoadjuvant chemotherapy at MD Anderson for stage I to III breast cancer between 1985 and 2004 with complete receptor data; 255 (23 percent) were triple-negative. Triple-negative patients had higher pathological complete response rates (22 versus 11 percent, p=0.034) but lower three-year progression-free and overall survival (both p<0.0001), more visceral metastases (p=0.0005), fewer bone recurrences (p=0.027) and shorter post-recurrence survival (p<0.0001), with excess recurrence and death confined to the first three years. Patients achieving pathological complete response had similar survival whether triple-negative or not (p=0.24); those with residual disease had worse survival if triple-negative (p<0.0001).

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: tnbc-evidence
- Journal: Journal of Clinical Oncology
- Year: 2008
- DOI: 10.1200/JCO.2007.14.4147
- Authors: Liedtke C, Mazouni C, Hess KR, et al.
- Findings: Pathological complete response 22 vs 11 percent for triple-negative vs other breast cancer (p=0.034).; Three-year progression-free and overall survival worse in triple-negative disease (p<0.0001); excess risk confined to the first three years.; With pathological complete response survival was equal (p=0.24); with residual disease triple-negative survival was worse (p<0.0001).
- What it means: Made pathological complete response the organising endpoint of triple-negative drug development and residual disease its central unsolved problem; every post-neoadjuvant trial from CREATE-X to ASCENT-05 follows from this observation.
- Caveats: Single-institution, retrospective, pre-taxane and taxane eras mixed.; Receptor testing methods changed over 1985 to 2004.

## Sources

- J Clin Oncol 2008: https://doi.org/10.1200/JCO.2007.14.4147
- PubMed: https://pubmed.ncbi.nlm.nih.gov/18250347/

## Connected records

- key papers: [Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy](https://onco.cc/key-papers/paper-create-x-adjuvant-capecitabine-nejm-2017/), [Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy](https://onco.cc/key-papers/paper-symmans-j-clin-oncol/), [Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis](https://onco.cc/key-papers/paper-cortazar-ctneobc-pcr-pooled-analysis-lancet-2014/)
- cancers: [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- institutions: [MD Anderson Cancer Center](https://onco.cc/institutions/md-anderson/)
- terms: [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Pathologic complete response (pCR)](https://onco.cc/terms/pcr/), [Residual cancer burden (RCB)](https://onco.cc/terms/rcb/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)
- roadmaps: [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/)

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