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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.
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).
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.
Established that residual disease after neoadjuvant chemotherapy is a treatable state, the principle behind OlympiA and the post-neoadjuvant antibody-drug conjugate trials; capecitabine remains the option for residual triple-negative disease without a BRCA variant in ESMO, NCCN and UK practice.
The basis of the US accelerated approval pathway on pathological complete response that KEYNOTE-522 and neoadjuvant trials since have used, together with the warning that a higher response rate in a trial is a promise, not a proof, of longer life.
Shares Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy, Residual cancer burden (RCB), Pathologic complete response (pCR), Neoadjuvant / adjuvant / perioperative and the tag tnbc-evidence.
Shares Pathologic complete response (pCR), Neoadjuvant / adjuvant / perioperative, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Journal of Clinical Oncology and the tag tnbc-evidence.
Shares MD Anderson Cancer Center, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Journal of Clinical Oncology, Triple-negative breast cancer (TNBC) and the tag tnbc-evidence.
Shares Pathologic complete response (pCR), Neoadjuvant / adjuvant / perioperative, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Journal of Clinical Oncology and the tag tnbc-evidence.
Shares Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy, Residual cancer burden (RCB), Neoadjuvant / adjuvant / perioperative, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem and the tag tnbc-evidence.
Shares Residual cancer burden (RCB), Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Triple-negative breast cancer (TNBC) and the tag tnbc-evidence.
Shares Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis, Pathologic complete response (pCR), Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Triple-negative breast cancer (TNBC) and the tag tnbc-evidence.
Shares Pathologic complete response (pCR), Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Triple-negative breast cancer (TNBC) and the tag tnbc-evidence.