Globally, triple-negative breast cancer (TNBC) is responsible for approximately 15% of all invasive Breast cancer and some retrospective studies have suggested a more advanced presentation and poorer treatment outcome in the Middle East and North African Arab countries. Nevertheless, there is complete lack of prospective reliable data on this topic. The TRIPOLI study aims to bridge this information gap.
Tripoli is an ongoing prospective multinational disease registry including newly diagnosed patients with TNBC from 17 institutions within 9 Arab countries. Herewith, we present Interim Analysis-2, including 590 patients with early TNBC (eTNBC). This report focuses on the treatment patterns and pathology outcomes for patients who received neoadjuvant chemotherapy (NAC).
Of the 590 patients with eTNBC that were included within TRIPOLI, 535 (90,6%) were stage II and III. 421 patients (71.5%) had a tumor size ≤ 5cm and majority of patients were grade 3 invasive ductal carcinomas. Only 213 (39,8%) were offered NAC and proceeded for surgery. Among those, 115 (54%) had tumor size ≤ 5cm and 139 (65%) had node+ disease. 163 (76%) received a combination of AC+T (Adriamycin/Cyclophosphamide + Taxane) while carboplatin was added in 43 (20%) patients. No patient received immune checkpoint inhibitors (ICIs). 70 (32,8%) patients achieved a pathological complete response (pCR). The pCR rate was 39,1% in patients who presented with stage II and 26,6% in those with stage III. Multivariate analysis of tumor size, histological subtype, grade ,lymph node involvement and addition of Carboplatin did not reveal any significant association with the pCR status. Among the 143 non-pCR patients, 45 (31.7%) received Capecitabine as adjuvant chemotherapy after surgery.
Baseline characteristics in patients treated in neoadjuvant setting differ in Middle East real-life practice from international clinical trials with more advanced tumors and less utilization of NAC during the study period. pCR rate achieved in this study is lower than what has been recently reported by more effective therapies including ICIs.
The authors.
MSD Sharp & Dohme.
H.A. Azim: Financial Interests, Personal, Research Grant: Pfizer, MSD, ASZ; Financial Interests, Personal, Speaker’s Bureau: Pfizer, Novartis, MSD, ASZ, Lilly, BMS, Roche, EVA Pharma; Financial Interests, Personal, Advisory Board: Pfizer, Novartis, MSD, ASZ, Lilly, BMS, Roche, EVA Pharma; Financial Interests, Personal, Invited Speaker: Pfizer, Novartis, MSD, ASZ, Lilly, BMS, Roche, EVA Pharma. All other authors have declared no conflicts of interest.