Abstract P4-10-09: Relapse-free survival of triple negative breast cancer long term survivors and characterization of late events in MD Anderson experience
Authors: Reddy SM , Sinha A , Syed M , Barcenas C , Valero V 
Published: May 2016

Background:

Stage I-III TNBC patients have a high risk of disease relapse during the first 5 years after diagnosis. However, there is limited data on the risk of late relapse in TNBC survivors who are disease free at 5 years or more from diagnosis. We sought to characterize this risk in a cohort of TNBC long-term survivors from a large institutional database.

Methods:

The MD Anderson Breast Cancer Management System database was queried for TNBC survivors who were disease free 5 years or more from diagnosis. Demographic, tumor, and treatment data was extracted. Electronic medical records were searched to confirm pathology reports for invasive breast cancer diagnosis, triple negative receptor status, and hormone receptor percentage (%). The primary and secondary outcomes of interest were relapse free survival (RFS) and distant relapse free survival (DRFS). Patients were censored at time of developing a second primary breast cancer or at last follow-up time for those who were alive during the study. We used ACP-ASCO definition of ER and PR &lt;1% and HER2/neu negative (IHC 0-1 or ratio &lt;2 and average copy number &lt;4) but also included patients with low ER/PR(1-9%) and HER2 normal. Kaplan-Meier analysis was performed to compare RFS and DRFS for the overall population and categorized by ER/PR &lt;1%, and ER/PR 1-9%.

Results:

We identified 1038 patients who had a median follow-up of 8.0 years. Receptor % information was available on 69% of patients, with 78% of them meeting current TNBC definition. From the total cohort of 130, 12.5% suffered event(s) that occurred after 5 years from diagnosis, with 86.2% of them occurring within 5-10 years of diagnosis. The event rate was 16.4% among patients with ER/PR 1-9% versus 11.3% among patients with ER/PR &lt;1%. Table 1 shows RFS and DRFS by year from diagnosis for the entire cohort and categorized by % receptor. 18 patients developed second primary breast cancer as first event and were censored. Of total events recorded, 53(40.8%) were deaths and 77(59.2%) were recurrences, of which 51(66%) were distant and 26(34%) local, of whom 12(46.2%) subsequently developed distant metastases. Among patients who initially presented with distant recurrence, frequencies of initial sites of metastases are shown in Table 2.

Conclusions:

TNBC long term survivors are still at risk for relapse events after 5 years from diagnosis, and it is important to quantity this risk when counseling our patients. Frequency of late events was higher among patients with low hormone receptor positivity. Multivariate modeling of predictors of late recurrence is ongoing.

Table 1: RFS and DRFS by Year from Diagnosis All PatientsER/PR &lt;1%ER/PR 1-9%Year From DiagnosisRFSDRFSRFSDRFSRFSDRFS4-51.01.01.01.01.01.05-60.950.960.940.950.940.956-70.930.940.930.940.910.927-80.900.920.900.920.870.898-90.860.880.870.890.810.849-100.840.870.840.860.800.8310-120.810.840.810.830.800.8312-150.730.780.730.750.670.74

Table 2: Site of Initial Distant RecurrenceSiteN (%)Lung/Pleura28 (54.9)Bone19 (37.3)Distant Lymph Nodes19 (37.3)Liver11 (21.6)Brain/Spinal Cord8 (15.7)Colorectal/Pancreas/Kidney/Adrenal6 (11.7)Other2 (3.9)*Patients presenting with multiple sites of distant recurrence are counted in each category.

Citation Format: Reddy SM, Sinha A, Syed M, Barcenas C, Valero V. Relapse-free survival of triple negative breast cancer long term survivors and characterization of late events in MD Anderson experience. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-10-09.