Background:Dose-dense adjuvant chemotherapy has been shown to be associated with improved long-term survival outcomes in triple-negative breast cancer (TNBC). However, there is a lacuna of data on the benefits of dose-dense neoadjuvant chemotherapy (NACT) in TNBC.This retrospective study included 217 newly diagnosed cases of TNBC treated with a sequential anthracycline and taxane-based NACT, followed by definitive surgery. Study groups consisted of 137 patients who received 3-weekly conventional chemotherapy (cNACT group) and 80 patients with 2-weekly dose-dense NACT (ddNACT group). Pathological complete response (pCR) rates, relapse-free survival (RFS), overall survival (OS), and grade-3/4 chemotoxicities were compared across the groups.No significant difference in the pCR rate (32.8% versus 31.3%; P = 0.808) was observed across the study groups. Relapse rate was lower in the ddNACT group compared to the cNACT group (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.27-0.95). However, ddNACT had no RFS advantage over conventional chemotherapy (median RFS: not reached versus 56.1 months in cNACT; hazard ratio: 0.90, 95% CI: 0.52-1.53). OS was also comparable in both the groups with a 3-year survival rate of 78.8% (95% CI: 60.9-89.2) in the ddNACT group versus 84.3% (95% CI: 74.8-90.4) in the cNACT group. Younger age, menopause, the Eastern Cooperative Oncology Group ECOG status, and pCR were significantly associated with OS in our cohort. Grade-3 toxicities were comparable in both groups.This observational study focusing on ddNACT among TNBC patients demonstrated significant differences in the relapse rate with no survival benefits. Differential effects of ddNACT by tumor presentation (early vs. late), tumor size, tumor biology, and cost-benefits of granulocyte colony-stimulating factor support with such regimens need further exploration.Dose-dense chemotherapy has been shown to be associated with improved long-term outcomes in triple-negative breast cancer (TNBC).[1] Currently, dose-dense neo-adjuvant (ddNACT) is the standard of care in patients with early and locally advanced stage TNBC based on the extrapolation of data from an adjuvant setting.[2] Neoadjuvant chemotherapy (NACT) provides the opportunity to assess pathological response following surgical resection, and attainment of pathological complete response (pCR) has become an established surrogate marker for assessing long-term survival in breast cancer, especially in TNBC and HER2+ (human-epidermal growth factor receptor-2) breast cancer subtypes.[3] Neoadjuvant chemotherapy with sequential anthracyclines and a taxane-based regimen is the current standard of care in TNBC, and a pCR rate of around 30-35% has been demonstrated with these regimens in various trials.[2] Recently, various strategies have been tested to increase the pCR rate in TNBC. Dose-dense neo-adjuvant chemotherapy has been shown to be associated with an increased rate of achievement of pCR.[4,5] Various strategies have been tried to increase the dose density of neoadjuvant chemotherapy, which include dose escalation, reducing the interval between chemotherapy cycles, and sequential administration of chemotherapeutic agents.[1] However, the dose-escalation strategy did not translate into an increased pCR rate.[3] Recently, the addition of platinum compounds or immune-checkpoint inhibitors along with chemotherapy has been studied.[6-10] These strategies have shown promising results and may become the standard of care in the future. [11]Despite being a common subtype, there is a lack of data on the impact of anthracycline and taxane-based dose-dense NACT and its effects on pCR and survival outcomes. With this analysis, we intend to study the pCR rate in TNBC patients who underwent definitive surgery and compared pCR rates between patients treated with dose-dense NACT and conventional NACT.Background:Dose-dense adjuvant chemotherapy has been shown to be associated with improved long-term survival outcomes in triple-negative breast cancer (TNBC). However, there is a lacuna of data on the benefits of dose-dense neoadjuvant chemotherapy (NACT) in TNBC.This retrospective study included 217 newly diagnosed cases of TNBC treated with a sequential anthracycline and taxane-based NACT, followed by definitive surgery. Study groups consisted of 137 patients who received 3-weekly conventional chemotherapy (cNACT group) and 80 patients with 2-weekly dose-dense NACT (ddNACT group). Pathological complete response (pCR) rates, relapse-free survival (RFS), overall survival (OS), and grade-3/4 chemotoxicities were compared across the groups.No significant difference in the pCR rate (32.8% versus 31.3%; P = 0.808) was observed across the study groups. Relapse rate was lower in the ddNACT group compared to the cNACT group (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.27-0.95). However, ddNACT had no RFS advantage over conventional chemotherapy (median RFS: not reached versus 56.1 months in cNACT; hazard ratio: 0.90, 95% CI: 0.52-1.53). OS was also comparable in both the groups with a 3-year survival rate of 78.8% (95% CI: 60.9-89.2) in the ddNACT group versus 84.3% (95% CI: 74.8-90.4) in the cNACT group. Younger age, menopause, the Eastern Cooperative Oncology Group ECOG status, and pCR were significantly associated with OS in our cohort. Grade-3 toxicities were comparable in both groups.This observational study focusing on ddNACT among TNBC patients demonstrated significant differences in the relapse rate with no survival benefits. Differential effects of ddNACT by tumor presentation (early vs. late), tumor size, tumor biology, and cost-benefits of granulocyte colony-stimulating factor support with such regimens need further exploration.Dose-dense chemotherapy has been shown to be associated with improved long-term outcomes in triple-negative breast cancer (TNBC).[1] Currently, dose-dense neo-adjuvant (ddNACT) is the standard of care in patients with early and locally advanced stage TNBC based on the extrapolation of data from an adjuvant setting.[2] Neoadjuvant chemotherapy (NACT) provides the opportunity to assess pathological response following surgical resection, and attainment of pathological complete response (pCR) has become an established surrogate marker for assessing long-term survival in breast cancer, especially in TNBC and HER2+ (human-epidermal growth factor receptor-2) breast cancer subtypes.[3] Neoadjuvant chemotherapy with sequential anthracyclines and a taxane-based regimen is the current standard of care in TNBC, and a pCR rate of around 30-35% has been demonstrated with these regimens in various trials.[2] Recently, various strategies have been tested to increase the pCR rate in TNBC. Dose-dense neo-adjuvant chemotherapy has been shown to be associated with an increased rate of achievement of pCR.[4,5] Various strategies have been tried to increase the dose density of neoadjuvant chemotherapy, which include dose escalation, reducing the interval between chemotherapy cycles, and sequential administration of chemotherapeutic agents. [1] However, the dose-escalation strategy did not translate into an increased pCR rate.[3] Recently, the addition of platinum compounds or immune-checkpoint inhibitors along with chemotherapy has been studied.[6-10] These strategies have shown promising results and may become the standard of care in the future.[11]Despite being a common subtype, there is a lack of data on the impact of anthracycline and taxane-based dose-dense NACT and its effects on pCR and survival outcomes. With this analysis, we intend to study the pCR rate in TNBC patients who underwent definitive surgery and compared pCR rates between patients treated with dose-dense NACT and conventional NACT.Background:Dose-dense adjuvant chemotherapy has been shown to be associated with improved long-term survival outcomes in triple-negative breast cancer (TNBC). However, there is a lacuna of data on the benefits of dose-dense neoadjuvant chemotherapy (NACT) in TNBC.This retrospective study included 217 newly diagnosed cases of TNBC treated with a sequential anthracycline and taxane-based NACT, followed by definitive surgery. Study groups consisted of 137 patients who received 3-weekly conventional chemotherapy (cNACT group) and 80 patients with 2-weekly dose-dense NACT (ddNACT group). Pathological complete response (pCR) rates, relapse-free survival (RFS), overall survival (OS), and grade-3/4 chemotoxicities were compared across the groups.No significant difference in the pCR rate (32.8% versus 31.3%; P = 0.808) was observed across the study groups. Relapse rate was lower in the ddNACT group compared to the cNACT group (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.27-0.95). However, ddNACT had no RFS advantage over conventional chemotherapy (median RFS: not reached versus 56.1 months in cNACT; hazard ratio: 0.90, 95% CI: 0.52-1.53). OS was also comparable in both the groups with a 3-year survival rate of 78.8% (95% CI: 60.9-89.2) in the ddNACT group versus 84.3% (95% CI: 74.8-90.4) in the cNACT group. Younger age, menopause, the Eastern Cooperative Oncology Group ECOG status, and pCR were significantly associated with OS in our cohort. Grade-3 toxicities were comparable in both groups.This observational study focusing on ddNACT among TNBC patients demonstrated significant differences in the relapse rate with no survival benefits. Differential effects of ddNACT by tumor presentation (early vs. late), tumor size, tumor biology, and cost-benefits of granulocyte colony-stimulating factor support with such regimens need further exploration.Dose-dense chemotherapy has been shown to be associated with improved long-term outcomes in triple-negative breast cancer (TNBC).[1] Currently, dose-dense neo-adjuvant (ddNACT) is the standard of care in patients with early and locally advanced stage TNBC based on the extrapolation of data from an adjuvant setting.[2] Neoadjuvant chemotherapy (NACT) provides the opportunity to assess pathological response following surgical resection, and attainment of pathological complete response (pCR) has become an established surrogate marker for assessing long-term survival in breast cancer, especially in TNBC and HER2+ (human-epidermal growth factor receptor-2) breast cancer subtypes.[3] Neoadjuvant chemotherapy with sequential anthracyclines and a taxane-based regimen is the current standard of care in TNBC, and a pCR rate of around 30-35% has been demonstrated with these regimens in various trials.[2] Recently, various strategies have been tested to increase the pCR rate in TNBC. Dose-dense neo-adjuvant chemotherapy has been shown to be associated with an increased rate of achievement of pCR.[4,5] Various strategies have been tried to increase the dose density of neoadjuvant chemotherapy, which include dose escalation, reducing the interval between chemotherapy cycles, and sequential administration of chemotherapeutic agents.[1] However, the dose-escalation strategy did not translate into an increased pCR rate.[3] Recently, the addition of platinum compounds or immune-checkpoint inhibitors along with chemotherapy has been studied.[6-10] These strategies have shown promising results and may become the standard of care in the future.[11]Despite being a common subtype, there is a lack of data on the impact of anthracycline and taxane-based dose-dense NACT and its effects on pCR and survival outcomes. With this analysis, we intend to study the pCR rate in TNBC patients who underwent definitive surgery and compared pCR rates between patients treated with dose-dense NACT and conventional NACT.Background:Dose-dense adjuvant chemotherapy has been shown to be associated with improved long-term survival outcomes in triple-negative breast cancer (TNBC). However, there is a lacuna of data on the benefits of dose-dense neoadjuvant chemotherapy (NACT) in TNBC.This retrospective study included 217 newly diagnosed cases of TNBC treated with a sequential anthracycline and taxane-based NACT, followed by definitive surgery. Study groups consisted of 137 patients who received 3-weekly conventional chemotherapy (cNACT group) and 80 patients with 2-weekly dose-dense NACT (ddNACT group). Pathological complete response (pCR) rates, relapse-free survival (RFS), overall survival (OS), and grade-3/4 chemotoxicities were compared across the groups.No significant difference in the pCR rate (32.8% versus 31.3%; P = 0.808) was observed across the study groups. Relapse rate was lower in the ddNACT group compared to the cNACT group (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.27-0.95). However, ddNACT had no RFS advantage over conventional chemotherapy (median RFS: not reached versus 56.1 months in cNACT; hazard ratio: 0.90, 95% CI: 0.52-1.53). OS was also comparable in both the groups with a 3-year survival rate of 78.8% (95% CI: 60.9-89.2) in the ddNACT group versus 84.3% (95% CI: 74.8-90.4) in the cNACT group. Younger age, menopause, the Eastern Cooperative Oncology Group ECOG status, and pCR were significantly associated with OS in our cohort. Grade-3 toxicities were comparable in both groups.This observational study focusing on ddNACT among TNBC patients demonstrated significant differences in the relapse rate with no survival benefits. Differential effects of ddNACT by tumor presentation (early vs. late), tumor size, tumor biology, and cost-benefits of granulocyte colony-stimulating factor support with such regimens need further exploration.Dose-dense chemotherapy has been shown to be associated with improved long-term outcomes in triple-negative breast cancer (TNBC).[1] Currently, dose-dense neo-adjuvant (ddNACT) is the standard of care in patients with early and locally advanced stage TNBC based on the extrapolation of data from an adjuvant setting.[2] Neoadjuvant chemotherapy (NACT) provides the opportunity to assess pathological response following surgical resection, and attainment of pathological complete response (pCR) has become an established surrogate marker for assessing long-term survival in breast cancer, especially in TNBC and HER2+ (human-epidermal growth factor receptor-2) breast cancer subtypes. [3] Neoadjuvant chemotherapy with sequential anthracyclines and a taxane-based regimen is the current standard of care in TNBC, and a pCR rate of around 30-35% has been demonstrated with these regimens in various trials.[2] Recently, various strategies have been tested to increase the pCR rate in TNBC. Dose-dense neo-adjuvant chemotherapy has been shown to be associated with an increased rate of achievement of pCR.[4,5] Various strategies have been tried to increase the dose density of neoadjuvant chemotherapy, which include dose escalation, reducing the interval between chemotherapy cycles, and sequential administration of chemotherapeutic agents.[1] However, the dose-escalation strategy did not translate into an increased pCR rate.[3] Recently, the addition of platinum compounds or immune-checkpoint inhibitors along with chemotherapy has been studied.[6-10] These strategies have shown promising results and may become the standard of care in the future.[11]Despite being a common subtype, there is a lack of data on the impact of anthracycline and taxane-based dose-dense NACT and its effects on pCR and survival outcomes. With this analysis, we intend to study the pCR rate in TNBC patients who underwent definitive surgery and compared pCR rates between patients treated with dose-dense NACT and conventional NACT.Background:Dose-dense adjuvant chemotherapy has been shown to be associated with improved long-term survival outcomes in triple-negative breast cancer (TNBC). However, there is a lacuna of data on the benefits of dose-dense neoadjuvant chemotherapy (NACT) in TNBC.This retrospective study included 217 newly diagnosed cases of TNBC treated with a sequential anthracycline and taxane-based NACT, followed by definitive surgery. Study groups consisted of 137 patients who received 3-weekly conventional chemotherapy (cNACT group) and 80 patients with 2-weekly dose-dense NACT (ddNACT group). Pathological complete response (pCR) rates, relapse-free survival (RFS), overall survival (OS), and grade-3/4 chemotoxicities were compared across the groups.No significant difference in the pCR rate (32.8% versus 31.3%; P = 0.808) was observed across the study groups. Relapse rate was lower in the ddNACT group compared to the cNACT group (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.27-0.95). However, ddNACT had no RFS advantage over conventional chemotherapy (median RFS: not reached versus 56.1 months in cNACT; hazard ratio: 0.90, 95% CI: 0.52-1.53). OS was also comparable in both the groups with a 3-year survival rate of 78.8% (95% CI: 60.9-89.2) in the ddNACT group versus 84.3% (95% CI: 74.8-90.4) in the cNACT group. Younger age, menopause, the Eastern Cooperative Oncology Group ECOG status, and pCR were significantly associated with OS in our cohort. Grade-3 toxicities were comparable in both groups.This observational study focusing on ddNACT among TNBC patients demonstrated significant differences in the relapse rate with no survival benefits. Differential effects of ddNACT by tumor presentation (early vs. late), tumor size, tumor biology, and cost-benefits of granulocyte colony-stimulating factor support with such regimens need further exploration.Dose-dense chemotherapy has been shown to be associated with improved long-term outcomes in triple-negative breast cancer (TNBC).[1] Currently, dose-dense neo-adjuvant (ddNACT) is the standard of care in patients with early and locally advanced stage TNBC based on the extrapolation of data from an adjuvant setting. [2] Neoadjuvant chemotherapy (NACT) provides the opportunity to assess pathological response following surgical resection, and attainment of pathological complete response (pCR) has become an established surrogate marker for assessing long-term survival in breast cancer, especially in TNBC and HER2+ (human-epidermal growth factor receptor-2) breast cancer subtypes.[3] Neoadjuvant chemotherapy with sequential anthracyclines and a taxane-based regimen is the current standard of care in TNBC, and a pCR rate of around 30-35% has been demonstrated with these regimens in various trials.[2] Recently, various strategies have been tested to increase the pCR rate in TNBC. Dose-dense neo-adjuvant chemotherapy has been shown to be associated with an increased rate of achievement of pCR.[4,5] Various strategies have been tried to increase the dose density of neoadjuvant chemotherapy, which include dose escalation, reducing the interval between chemotherapy cycles, and sequential administration of chemotherapeutic agents.[1] However, the dose-escalation strategy did not translate into an increased pCR rate.[3] Recently, the addition of platinum compounds or immune-checkpoint inhibitors along with chemotherapy has been studied.[6-10] These strategies have shown promising results and may become the standard of care in the future.[11]Despite being a common subtype, there is a lack of data on the impact of anthracycline and taxane-based dose-dense NACT and its effects on pCR and survival outcomes. With this analysis, we intend to study the pCR rate in TNBC patients who underwent definitive surgery and compared pCR rates between patients treated with dose-dense NACT and conventional NACT.Background:Dose-dense adjuvant chemotherapy has been shown to be associated with improved long-term survival outcomes in triple-negative breast cancer (TNBC). However, there is a lacuna of data on the benefits of dose-dense neoadjuvant chemotherapy (NACT) in TNBC.This retrospective study included 217 newly diagnosed cases of TNBC treated with a sequential anthracycline and taxane-based NACT, followed by definitive surgery. Study groups consisted of 137 patients who received 3-weekly conventional chemotherapy (cNACT group) and 80 patients with 2-weekly dose-dense NACT (ddNACT group). Pathological complete response (pCR) rates, relapse-free survival (RFS), overall survival (OS), and grade-3/4 chemotoxicities were compared across the groups.No significant difference in the pCR rate (32.8% versus 31.3%; P = 0.808) was observed across the study groups. Relapse rate was lower in the ddNACT group compared to the cNACT group (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.27-0.95). However, ddNACT had no RFS advantage over conventional chemotherapy (median RFS: not reached versus 56.1 months in cNACT; hazard ratio: 0.90, 95% CI: 0.52-1.53). OS was also comparable in both the groups with a 3-year survival rate of 78.8% (95% CI: 60.9-89.2) in the ddNACT group versus 84.3% (95% CI: 74.8-90.4) in the cNACT group. Younger age, menopause, the Eastern Cooperative Oncology Group ECOG status, and pCR were significantly associated with OS in our cohort. Grade-3 toxicities were comparable in both groups.This observational study focusing on ddNACT among TNBC patients demonstrated significant differences in the relapse rate with no survival benefits. Differential effects of ddNACT by tumor presentation (early vs. late), tumor size, tumor biology, and cost-benefits of granulocyte colony-stimulating factor support with such regimens need further exploration. Dose-dense chemotherapy has been shown to be associated with improved long-term outcomes in triple-negative breast cancer (TNBC).[1] Currently, dose-dense neo-adjuvant (ddNACT) is the standard of care in patients with early and locally advanced stage TNBC based on the extrapolation of data from an adjuvant setting.[2] Neoadjuvant chemotherapy (NACT) provides the opportunity to assess pathological response following surgical resection, and attainment of pathological complete response (pCR) has become an established surrogate marker for assessing long-term survival in breast cancer, especially in TNBC and HER2+ (human-epidermal growth factor receptor-2) breast cancer subtypes.[3] Neoadjuvant chemotherapy with sequential anthracyclines and a taxane-based regimen is the current standard of care in TNBC, and a pCR rate of around 30-35% has been demonstrated with these regimens in various trials.[2] Recently, various strategies have been tested to increase the pCR rate in TNBC. Dose-dense neo-adjuvant chemotherapy has been shown to be associated with an increased rate of achievement of pCR.[4,5] Various strategies have been tried to increase the dose density of neoadjuvant chemotherapy, which include dose escalation, reducing the interval between chemotherapy cycles, and sequential administration of chemotherapeutic agents.[1] However, the dose-escalation strategy did not translate into an increased pCR rate.[3] Recently, the addition of platinum compounds or immune-checkpoint inhibitors along with chemotherapy has been studied.[6-10] These strategies have shown promising results and may become the standard of care in the future.[11]Despite being a common subtype, there is a lack of data on the impact of anthracycline and taxane-based dose-dense NACT and its effects on pCR and survival outcomes. With this analysis, we intend to study the pCR rate in TNBC patients who underwent definitive surgery and compared pCR rates between patients treated with dose-dense NACT and conventional NACT.
