Abstract

Rana Saeed El-Sayed Ata, Lamiss Mohamed Abd El-Aziz, Ayman Mohamed El-Saqa MD and Asmaa Mohamed El-Kady*

ABSTRACT

Background: Triple negative breast cancer is a subtype of breast cancer that shows minimal or no immunohistochemical expression of estrogens receptor, progesterone receptor and human epidermal growth factor receptor 2 (HER2), & accounts for ~12% of invasive breast cancers. Patients with TNBC who received carboplatin had a significant three-fold increased probability of pathological complete response if the breast cancer was lymphocytic predominant. The presence of CD8+ cells in the tumor infiltrate prior to the onset of neoadjuvant chemotherapy (NAC) predicted pCR in several studies. Aim: Comparison between paclitaxel and doxorubicin versus paclitaxel and carboplatin as neoadjuvant chemotherapy in triple negative breast cancer as regard treatment response, survival rates and toxicity analysis of different prognostic factors with special emphasis on tumour infiltrating lymphocytes (TILs) and their immunophenotyping profile as a prognostic and predictive marker. Patients and methods: This retrospective study included 40 patients with TNBC stage II, III treated with NAC at Clinical Oncology and Nuclear Medicine Department Tanta University Hospitals and Oncology Department of Health Insurance hospitals throughout the period from January 2011 to December 2015. Twenty patients were treated with paclitaxel and doxorubicin (Group A) while 20 patients were treated with paclitaxel and carboplatin (Group B). Results: Paclitaxel and carboplatin showed higher overall response (OAR) and pCR (90%, 40%) respectively vs (75%, 5%) for paclitaxel and doxorubicin. Five-year OS, DFS were higher in carboplatin, paclitaxel group. High TILs tumors showed higher pCR, 5-year OS and DFS versus low, moderate TILs tumors. Conclusion: Platinum-based chemotherapy drugs are more effective in TNBC as neoadjuvant chemotherapy. Increasing numbers of stromal TILs were associated with improved pCR, OS, DFS in TNBC. Increased stromal expressions of CD3 and CD8 were all significantly associated with pCR.