J Cancer 2020; 11(22):6653-6662. doi:10.7150/jca.44768 This issue

Research Paper

The taxane-based chemotherapy triplet is superior to the doublet in one to nine node-positive but not node-negative triple-negative breast cancer: results from a retrospective analysis

Sanxing Guo1, Yonggang Shi2, Shuo Lu3, Yujie He4, Guangyi Jin5,6, Suzhi Zhang7✉, Xingya Li1✉

1. Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
2. Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
3. School of Basic Medicine, Guangdong Medical University, Shenzhen, China
4. Rheumatology and Immunology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
5. International Cancer Center, Shenzhen University Health Science Center, Shenzhen, China
6. National Engineering Lab for Synthetic Biology of Medicine, Shenzhen University, Shenzhen, China
7. Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

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Citation:
Guo S, Shi Y, Lu S, He Y, Jin G, Zhang S, Li X. The taxane-based chemotherapy triplet is superior to the doublet in one to nine node-positive but not node-negative triple-negative breast cancer: results from a retrospective analysis. J Cancer 2020; 11(22):6653-6662. doi:10.7150/jca.44768. Available from https://www.jcancer.org/v11p6653.htm

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Abstract

Background: Taxane-based regimens that are frequently used in adjuvant chemotherapy in early triple-negative breast cancer (TNBC) include a three-drug regimen (TAC and AC-T) and a two-drug regimen (TA and TC). Whether pathological lymph node stage guides taxane-based de-escalating chemotherapies in TNBC in adjuvant setting is still unclear.

Methods: We retrospectively examined 381 patients with early TNBC over a median follow-up period of 75.9 months and compared the disease-free survival (DFS) and overall survival (OS) of patients who received adjuvant taxane-based three-drug chemotherapy and two-drug chemotherapy according to pathological lymph node stage (negative, pN0; 1-3 positive, pN1; 4-9 positive, pN2).

Results: In 222 pN0 patients, the taxane-based three-drug regimen was not superior to the two-drug regimen. In 159 pN1-2 patients, the taxane-based three-drug regimen significantly improved DFS (5-year DFS rate, 78.2% vs. 46.9%; log-rank p=0.0002) and OS (5-year OS rate, 90.7% vs. 64.3%; log-rank p=0.0001) compared with the two-drug regimen. In a multivariable Cox regression analysis of pN1-2 patients, after adjustment for clinical characteristics, the taxane-based three-drug regimen significantly decreased the risk of recurrence (adjusted HR, 0.37; 95% CI, 0.22 to 0.64; p=0.0004) and death (adjusted HR, 0.22; 95% CI, 0.10 to 0.48; p=0.0001) compared with the two-drug regimen.

Conclusions: The taxane-based chemotherapy triplet is superior to the chemotherapy doublet in patients with one to nine positive lymph nodes but not node-negative TNBC in adjuvant setting. These data suggest that pathological lymph node stage leads to de-escalating chemotherapy strategies in operable TNBC patients.

Keywords: triple-negative breast cancer, taxane-based regimen, chemotherapy, lymph node stage