Treatment Patterns, Trends, and Outcomes of Neoadjuvant Chemotherapy Use Among Patients With Early-Stage Invasive Triple-Negative Breast Cancer.

Abstract

Purpose: Triple-negative breast cancer (TNBC) is a clinically aggressive subtype associated with poorer survival outcomes. We examined the patterns and trends in neoadjuvant chemotherapy (NACT) use, pathologic complete response (pCR), and overall survival (OS). Furthermore, we evaluated the association between pCR and OS in a large cohort of patients.

Methods: Patients aged 18 years and older with stage I-III TNBC diagnosed between 2010 and 2021 were identified in the National Cancer Database. Trends in NACT use, pCR, and OS were assessed using the Cochran-Armitage test for time trends. Multivariable logistic regression was used to evaluate the factors associated with NACT use and pCR. The impact of pCR on OS was examined using a multivariable Cox proportional hazards model with propensity score (PS) adjustment and matching.

Results: The rate of NACT receipt increased from 19.1% to 56.4% (P < .001) between 2010 and 2021. Among those who received NACT, pCR rates increased from 19.6% to 40.3% between 2010 and 2021 (P < .001). Notably, 3- and 5-year OS rates increased among those with residual disease, while OS remained stable among those who achieved a pCR. Compared with non-Hispanic White patients, Black patients were less likely to receive NACT (adjusted odds ratio [aOR], 0.88 [95% CI, 0.85 to 0.91]) or achieve pCR (aOR, 0.90 [95% CI, 0.85 to 0.95]). Among patients treated with NACT, having a pCR was associated with a lower risk of death (adjusted hazard ratio, [aHR], 0.26 [95% CI, 0.24 to 0.29]).

Conclusion: The use of NACT among patients with TNBC has dramatically increased in the past decade. Although TNBC is more prevalent in Black patients, they were less likely to be treated with NACT and less likely to achieve a pCR. Further research is needed to elucidate the underlying disparities and advance drug development to enhance outcomes.