Clinical characteristics of triple negative breast cancer in Egyptian women: a hospital-based experience
Abstract
Purpose: Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer with poor prognosis despite the high rates of response to chemotherapy. We aim to study the clinical features, factors influencing recurrence and survival outcomes of TNBC patients.
Methods: We retrospectively studied the charts of patients with biopsy proven TNBC treated at The Clinical Oncology Department Ain-Shams University between 2009 and 2012.
Results: One hundred and forty five patients fulfilled the eligibility criteria. The incidence of TNBC was 10.5% - 15% with a mean of 12% of all breast cancer patients. The follow-up duration ranged from six months to four years. The age range was 26 to 78 years. Infiltrating ductal carcinoma represented 93.1% of the pathologic types. 87% of patients were free of metastases (M0) at presentation. Clinical stages II and III represented 38 and 39.5% of the patients. 66% of patients had modified radical mastectomy. Following surgery, 77.5% of patients received adjuvant chemotherapy while 61% of the patients had adjuvant radiation therapy. Anthracyclines based chemotherapy was given to 52% of patients. Disease-free survival (DFS) of the M0 patients at 20 and 30 months was 92% and 80% respectively. Relapse occurred in 23% of M0 patients. After a mean duration of DFS of 15.1 months, the most common sites of metastases for relapsed M0 patients were pulmonary (44.8%), bone (41.4%), and locoregional (13.8%). The median overall survival (ORS) of patients was 18 months (1 - 45 months), whereas for the M1 group of patients the median ORS was 9 months (2 - 29 months).
Conclusion: The incidence, pathological characteristics, and clinical behavior of TNBC were similar to what is mentioned in the literature. Adding taxanes to the chemotherapy protocols and using postoperative radiotherapy were both associated with a significant increase in the mean period of DFS, while did not significantly affect the ORS.
Keywords
Full Text:
PDFReferences
Dent R, Trudeau M, Pritchard KI, et al. Triple negative breast cancer: Clinical features and patterns of recurrence. Clin Cancer Res. 2007; 13: 4429-34.
Prat A, Parker JS , Karginova O, et al. Phenotypic and molecular characterization of the claudin-low intrinsic subtype of breast cancer. Breast Cancer Res. 2010; 12(5):R68.
Yanagawa M, Ikemot K, Kawauchi S, et al. Luminal A and luminal B (HER2 negative) subtypes of breast cancer consist of a mixture of tumors with different genotype. BMC Res Notes. 2012; 5:376.
Jia LYI, Shanmugam MK, Sethi G, et al. Potential role of targeted therapies in the treatment of triple-negative breast cancer. Anticancer drugs. 2016;27(3):147-55.
Lehmann BD, Bauer JA, Chen X, et al. Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. J Clin Invest. 2011; 121:2750-67.
Kaplan HG, Malmgren JA. Impact of triple negative phenotype on breast cancer prognosis. Breast J. 2008; 14:456–63.
Lin NU, Vanderplas A, Hughes ME, et al. Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National comprehensive cancer network. Cancer. 2012.
Liedke C, Mazouni C, Hess KR, et al. Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol. 2008; 26:1275–81.
Rakha EA, El-Sayed M, Green A, et al. Prognostic markers in triple-negative breast cancer. Cancer. 2007; 109:25–32.
Ghosn M, Hajj C, Kattan J, et al. Triple-negative breast cancer in Lebanon: a case series. Oncologist. 2011; 16:1552–6.
Heitz F, Harter P, Traut A, et al. Cerebral metastases (CM) in breast cancer (BC) with focus on triple-negative tumors. J Clin Oncol. 2008;26 (15 suppl) (abstract 1010).
Goldhirsch A, Wood WC, Coates AS, et al. Panel members. Strategies for subtypes-dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer. Ann Oncol. 2011;22(8):1736–47.
Rais G, Raissouni S, Aitelhaj M, et al. Triple-negative breast cancer in women: clinicopathologic and therapeutic study at the National Institute of Oncology. BMC Women’s Health. 2012; 12:35.
Abulkair O, Moghraby J, Badri M, et al. Clinicopathologic features and prognosis of triple negative breast cancer in patients 40 years of age and younger in Saudi Arabia. Hematol Oncol Stem Cell Ther. 2012;5(2);101-6.
Hamm C, El-Masri M, Poliquin G, et al. A single-center chart review exploring the adjusted association between breast cancer phenotype and prognosis. Curr Oncol. 2011; 18:191–6.
Lee JA, Kim KI, Bae JW, et al. Korean Breast Cancer Society. Triple negative breast cancer in Korea-distinct biology with different impact of prognostic factors on survival. Breast Cancer Res Treat. 2010; 123:177-87.
Carey L, Perou C, Livasy C, et al. Race, breast cancer subtypes, and survival in the Carolina breast cancer study. JAMA. 2006; 295:2492-502.
Bauer KR, Brown M, Cress RD et al. Descriptive analysis of estrogen receptor (ER) negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple negative phenotype: A population-based study from the California Cancer Registry. Cancer 2007; 109:1721-8.
Tawfik O, Davis K, Kimler BF, et al. Clinicopathological characteristics of triple - negative invasive mammary carcinomas in African-American versus Caucasian women. Ann Clin lab Sci. 2010 Fall;40(4):315-23.
Kwan ML, Kushi LH, Weltzien E, et al. Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors. Breast cancer Res. 2009; 11(3):R31.
Park YH, Lee SJ, Cho EY, et al. Clinical Relevance of TNM staging systems according to breast cancer subtypes. Ann Oncol. 2011;22(7):1554-60.
Akosky S, Dizdar O, Harputluoglu H, et al. Demographic, clinical, and pathological characteristics of Turkish triple-negative breast cancer: single center experience. Ann Oncol. 2007;18(11):1904-6.
Thike AA, Cheok PY, Jara-Lazaro AR, et al. Triple-negative breast cancer: clinicopathological characteristics and relationship with basal-like breast cancer. Mod Pathol. 2010; 23(1): 123-33.
Fakhoury W. Prognostic Factor in Breast Cancer; Correlation with Other Factors; Estrogen and Progesterone Receptors, MIB and Histoprognostic Grade. Thesis. Saint-Joseph University, Beirut, Lebanon, 1996–1997:1–50.
Fayaz MS, El-Sherify MS, El-Basmy A et al. Clinicopathological features and prognosis of triple negative breast cancer in Kuwait: A comparative/perspective analysis. Reports of practical oncology and radiotherapy. 2014; 19:173-81.
Phipps AI, Chlebowski RT, Prentice R, et al. Body size, physical activity, and risk of triple-negative and estrogen receptor-positive breast cancer. Cancer Epidemiol Biomarkers Prev. 2011;20(3):454-63.
Lin C, Chien SY, Chen LS, et al. Triple negative breast carcinoma is a prognostic factor in Taiwanese women. BMC Cancer. 2009; 18; 9:192.
Fulford LG, Easton DF, Reis-Filho JS, et al. Specific morphological features predictive for the basal phenotype in grade 3 invasive ductal carcinoma of breast. Histopathology. 2006; 49:22-34.
Lakhani SR, Reis-Filho JS, Fulford L, et al. Prediction of BRCA1 status in patients with breast cancer using estrogen receptor and basal phenotype. Clin Cancer Res. 2005;15;11(14):5175-80.
Livasy CA, Karaca G, Nanda R, et al. Phenotypic evaluation of the basal-like subtype of invasive breast carcinoma. Mod Pathol. 2006; 19:264–71.
Tsuda H, Takarabe T, Hasegawa T, et al. Myoepithelial differentiation in high grade invasive ductal carcinomas with large central acellular zones. Hum Pathol. 1999; 30:1134-9.
Tsuda H, Takarabe T, Hasegawa F, et al. Large, central acellular zones indicating myoepithelial tumor differentiation in high-grade invasive ductal carcinomas as markers of predisposition to lung and brain metastases. Am J SurgPathol. 2000; 24:197–202.
Ishikawa Y, Horiguchi J, Toya H, et al. Triple-negative breast cancer: histological subtypes and immunohsitochemical and clinicopathological features. Cancer Sci. 2011;102(3):656-62.
Montagna E, Maisonneuve P, Rotmensz N, et al. Heterogeneity of triple negative breast cancer: histologic subtyping to inform the outcome. Clin Breast Cancer. 2013;13(1):31-9.
Monhollen L, Morrison C, Ademuyiwa FO, et al. Pleomorphic lobular carcinoma: a distinctive clinical and molecular breast cancer type. Histopathology. 2012;61(3):365–77.
Foulkes WD, Brunet JS, Stefansson IM, et al. The prognostic implication of the basal-like (cyclin E high/p27low/p53+/glomeruloid-microvascular proliferation+) phenotype of BRCA1-related breast cancer. Cancer Res. 2004; 64:830-5.
Tian XS, Cong MH, Zhou WH, et al. Clinicopathologic and prognostic characteristics of triple-negative breast cancer. Onkologie. 2008;31(11):610-4.
Dogan L, Atalay C, Yilmaz KB, et al. Prognosis in hormone receptor negative breast cancer patients according to ERBB2 status. Neoplasma. 2008;55(6):544-8.
El Saghir NS, Seoud M, Khalil MK, et al. Effects of young age at presentation on survival in breast cancer. BMC Cancer. 2006; 6:194.
Pogoda K, Niwinska A, Muawska M, et al. Analysis of pattern, time, and risk factors influencing recurrence in triple-negative breast cancer patients. Med Oncol. 2013; 30:388.
Stark A, Kapke A, Schultz D, et al. Advanced stages and poorly differentiated grade are associated with an increased risk of HER2/neu positive breast cancer only in white women: findings from a prospective cohort study of African-American and white-American women. Breast Cancer Res Treat. 2008; 107:405-14.
Billar JA, Dueck AC, Stucky CC, et al. Triple-negative breast cancers: unique clinical presentations and outcomes. Ann Surg Oncol. 2010;17(Suppl. 3):384-90.
Nishimura R, Arima N. Is triple negative a prognostic factor in breast cancer? Breast Cancer. 2008;15(4):303-8.
Chivukula M, Striebel JM, Ersahin C, et al. Evaluation of morphologic features to identify “basal-like phenotype” on core needle biopsies of breast. Appl Immunohistochem Mol Morphol 2008; 16:411-6.
Amar S, McCullough AE, Tan W, et al. Prognosis and outcome of small (<=1 cm), node-negative breast cancer on the basis of hormonal and HER-2 status. Oncologist. 2010;15(10):1043-9.
Carey LA, Dees EC, Sawyer L, et al. The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res. 2007; 13:2329-34.
Wang S, Yang H, Tong F, et al. Response to neoadjuvant therapy and disease free survival in patients with triple-negative breast cancer. GanTo Kagaku Ryoho. 2009;36(2):255–8.
Lund MJ, Butler EN, Bumpers HL, et al. High prevalence of triple-negative tumors in an urban cancer center. Cancer. 2008;113(3):608-15.
Dent R, Hanna WM, Trudeau M, et al. Pattern of metastatic spread in triple negative breast cancer. Breast Cancer Research Treatment. 2009;115(2):423-8.
Haffty BG, Yang Q, Reiss M, et al. Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer. J Clin Oncol. 2006;24(36):5652-7.
Mayer IA, Abramson VG, Lehmann BD, et al. New Strategies for triple-negative breast cancer-deciphering the heterogeneity. Clin Cancer Res. 2014;20(4):782-90.
Lehmann BD, Pietenpol JA, Tan AR. Triple-negative breast cancer: molecular subtypes and new targets for therapy. Am SocClin Oncol Educ Book. 2015:e31-9.
Tentori L, Graziani G. Chemopotentiationby PARP inhibitors in cancer therapy. Pharmacol Res. 2005; 52:25.
Tutt A, Robson M, Garber JE, et al. Oral poly (ADP-ribose) polymerase inhibitor olaparib in patients with BRCA1 or BRCA2 mutations and advanced breast cancer: a proof-of-concept trial. Lancet. 2010; 376:235.
O'Shaughnessy J, Osborne C, Pippen JE, et al. Iniparib plus chemotherapy in metastatic triple-negative breast cancer. N Engl J Med. 2011;364(3):205-14.
Isakoff SJ, Overmoyer B, Tung NM, et al. A phase II trial of the PARP inhibitor veliparib (ABT888) and temozolomide for metastatic breast cancer. J Clin Oncol. 2010;28(15s): p. abstr 1019.
Tutt A, Robson M, Garber JE, et al. Phase II trial of the oral PARP inhibitor olaparib in BRCA-deficient advanced breast cancer. J Clin Oncol. 2009; 27(18s):p. Abstract CRA501.
Gelmon KA, Hirte HW, Robidoux KS, et al. Can we define tumors that will respond to PARP inhibitors? A phase II correlative study of olaparib in advanced serous ovarian cancer and triple-negative breast cancer. J Clin Oncol. 2010;28(15s): p. abstr 3002.
Baselga J, Gomez P, Greil R, et al. Randomized phase II study of the anti-epidermal growth factor receptor monoclonal antibody cetuximab with cisplatin versus cisplatin alone in patients with metastatic triple-negative breast cancer. J Clin Oncol. 2013;31(20):2586-92.
O’Shaughnessy J, Weckstein D, Vukelja S. Pre-liminary Preliminary results of a randomized phase II study of weekly irinotecan/carboplatin with or without cetuximab in pa-tients patients with metastatic breast cancer. Breast Cancer Res Treat. 2007; 106:S32-S33.
DOI: http://dx.doi.org/10.14319/ijcto.42.6

This work is licensed under a Creative Commons Attribution 3.0 License.
International Journal of Cancer Therapy and Oncology (ISSN 2330-4049)
© International Journal of Cancer Therapy and Oncology (IJCTO)
To make sure that you can receive messages from us, please add the 'ijcto.org' domain to your e-mail 'safe list'. If you do not receive e-mail in your 'inbox', check your 'bulk mail' or 'junk mail' folders.