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Have all triple-negative breast cancer patients worse breast cancerspecific survival?
Keywords: Breast cancer Triple negative Radiation therapy Subtypes
determining pCR rates after primary systemic therapy based on TNBC subtypes as described by Lehmann et al. [3]. Interestingly, BL1 subtype had the highest pCR rate (52%). Paradoxically, BL2 and LAR subtypes had the lowest pCR rates (0% and 10%, respectively). These results revealed that not all TNBC patients may carry worse prognostic features like BL-1 type TNBC patients. Therefore, TNBC patients receiving postoperative radiation therapyor not should be classified according to TNBC subtypes. Further studies are needed to confirm my proposal. Conflicts of interest
Dear Editor, I want to congratulate Kindts and colleagues for their article in which they investigated the loco regional recurrence (LRR) and breast cancer-specific survival (BCSS) after breast-conserving therapy (BCT) or mastectomy (ME) with or without radiation therapy (RT) in triple-negative breast cancer (TNBC). They reported that TNBC patients treated with ME without postoperative radiation therapy showed significant lower BCSS compared to patients treated with BCT or ME þ RT and significant more LRR compared to MEþRT when corrected for known clinicopathological prognostic factors [1]. Interestingly, TNBC is a heterogeneous disease showing different prognostic features. 20%e30% of patients with TNBC had a pathological complete response (pCR) to primary systemic therapy and pCR was found to be strongly associated with prolonged overall survival (OS) and event-free survival [2]. Recent gene expression analyses have identified molecular subtypes of TNBC. Pivotal study by Lehmann et al. reported that TNBC are classified into 7 subtypes (6 defined subtypes and an unstable group) by gene expression microarray [3]. Seven TNBC subtypes were characterized as basal-like 1 (BL1), basal-like 2 (BL2), immunomodulatory (IM), mesenchymal (M), mesenchymal stem-like (MSL), luminal androgen receptor (LAR), and unstable (UNS). Masuda et al. [4] explored the clinical relevancy of TNBC heterogeneity by
The author indicated no potential conflicts of interest.
References [1] Kindts I, Buelens P, Laenen A, Van Limbergen E, Janssen H, Wildiers H, et al. Omitting radiation therapy in women with triple-negative breast cancer leadsto worse breast cancer-specific survival. Breast 2016 Dec 21;32. 18e25v. [2] von Minckwitz G, Untch M, Blohmer JU, Costa SD, Eidtmann H, Fasching PA, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol 2012;30:1796e804. [3] Lehmann BD, Bauer JA, Chen X, Sanders ME, Chakravarthy AB, Shyr Y, et al. Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. J Clin Invest 2011;121:2750e67. [4] Masuda H, Baggerly KA, Wang Y, Zhang Y, Gonzalez-Angulo AM, MericBernstam F, et al. Differential response to neoadjuvant chemotherapy among 7 triple-negative breast cancer molecular subtypes. Clin Cancer Res 2013;19: 5533e40.
Kadri Altundag MKA Breast Cancer Clinic, Tepe Prime, Cankaya, 06800, Ankara, Turkey E-mail address:
[email protected]. 26 December 2016 Available online xxx
http://dx.doi.org/10.1016/j.breast.2017.01.006 0960-9776/© 2017 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Altundag KHave all triple-negative breast cancer patients worse breast cancer-specific survival?, The Breast (2017), http://dx.doi.org/10.1016/j.breast.2017.01.006