Identifying Patients with Early-Stage Triple-Negative Breast Cancer Who Can Safely Avoid Chemotherapy Based on Stromal Tumor-Infiltrating Lymphocyte Levels

المفاهيم الأساسية

Patients with stage I triple-negative breast cancer (TNBC) who have high levels of stromal tumor-infiltrating lymphocytes (TILs) demonstrate excellent 10-year breast cancer-specific survival without chemotherapy, suggesting stromal TILs could be a useful biomarker to optimize treatment decisions in this patient population.

الملخص

The study analyzed a cohort of 1,041 women with stage I TNBC who did not receive neoadjuvant or adjuvant chemotherapy. The researchers found that:

• Patients with smaller tumors (pT1abN0) had better 10-year breast cancer-specific survival (92%) compared to those with larger tumors (pT1cN0, 86%).
• Patients with stromal TIL levels of 30% or higher had significantly better 10-year breast cancer-specific survival (96%) compared to those with lower TIL levels (87%).
• For patients with pT1c tumors, those with stromal TIL levels of 30% or higher had a 10-year breast cancer-specific survival of 95% compared to 83% for those with lower TIL levels.
• The 10-year breast cancer-specific survival improved to 98% among patients with stromal TIL levels of 75% or higher.

The authors suggest that assessing stromal TIL levels could be an inexpensive biomarker to identify patients with stage I TNBC who may safely avoid chemotherapy, and recommend conducting treatment-optimization clinical trials using stromal TIL levels as an integral biomarker.

الإحصائيات

Patients with pT1abN0 tumors had a 10-year breast cancer-specific survival of 92%.
Patients with pT1cN0 tumors had a 10-year breast cancer-specific survival of 86%.
Patients with stromal TIL levels ≥30% had a 10-year breast cancer-specific survival of 96%.
Patients with stromal TIL levels <30% had a 10-year breast cancer-specific survival of 87%.
Patients with pT1c tumors and stromal TIL levels ≥30% had a 10-year breast cancer-specific survival of 95%.
Patients with pT1c tumors and stromal TIL levels <30% had a 10-year breast cancer-specific survival of 83%.
Patients with stromal TIL levels ≥75% had a 10-year breast cancer-specific survival of 98%.

اقتباسات

"Patients with stage I triple-negative breast cancer (TNBC) who have higher levels of stromal tumor-infiltrating lymphocytes (TILs) demonstrate 'excellent' 10-year breast cancer–specific survival without chemotherapy."
"The results supported the establishment of 'treatment-optimization clinical trials in patients with stage I TNBC, using [stromal] TIL level as an integral biomarker to prospectively confirm the observed excellent survival when neoadjuvant or adjuvant chemotherapy is not administered.'"

الرؤى الأساسية المستخلصة من

Which Patients With Early TNBC Can Avoid Chemotherapy?

by Liam Davenpo... في www.medscape.com 07-26-2024

https://www.medscape.com/viewarticle/which-patients-early-tnbc-can-avoid-chemotherapy-2024a1000ds5

استفسارات أعمق

What are the potential mechanisms by which high stromal TIL levels confer improved survival in early-stage TNBC patients without chemotherapy?

The presence of high levels of stromal tumor-infiltrating lymphocytes (TILs) in early-stage triple-negative breast cancer (TNBC) patients without chemotherapy can potentially improve survival through several mechanisms. TILs are a crucial component of the immune response against tumors. They can directly target and kill cancer cells, inhibit tumor growth, and prevent metastasis. Additionally, TILs can enhance the body's immune response by activating other immune cells, such as cytotoxic T cells and natural killer cells, to further attack cancer cells. High stromal TIL levels indicate a robust immune response within the tumor microenvironment, which can lead to better control and elimination of cancer cells, ultimately improving patient outcomes.

How do the findings of this observational study compare to the results of prospective clinical trials evaluating the role of TILs in guiding treatment decisions for early-stage TNBC?

The findings of this observational study provide valuable insights into the potential role of stromal TIL levels as a biomarker to guide treatment decisions in early-stage triple-negative breast cancer (TNBC) patients. While observational studies like this one can offer important preliminary evidence, prospective clinical trials are essential to validate and confirm these findings. Prospective trials involve a more rigorous study design, including randomization and control groups, which can provide stronger evidence of the effectiveness of using stromal TIL levels to determine the need for chemotherapy in early-stage TNBC. By comparing the results of this observational study to the outcomes of prospective clinical trials, researchers can assess the consistency and reliability of using stromal TILs as a predictive biomarker in clinical practice.

Given the limitations of the study, such as the lack of data on BRCA mutation status and recurrence/metastasis, what additional research is needed to fully validate the use of stromal TILs as a biomarker to safely omit chemotherapy in early-stage TNBC?

To fully validate the use of stromal tumor-infiltrating lymphocytes (TILs) as a biomarker to safely omit chemotherapy in early-stage triple-negative breast cancer (TNBC), further research is needed to address the limitations of the current study. Future studies should include comprehensive data on BRCA1 and BRCA2 germline mutation status, as these genetic factors can influence treatment outcomes and response to chemotherapy. Additionally, long-term follow-up data on recurrence and distant metastases are crucial to evaluate the efficacy of using stromal TIL levels as a predictive marker for treatment decisions. Prospective clinical trials with larger sample sizes and diverse patient populations can provide more robust evidence to support the implementation of stromal TIL assessment in clinical practice. Collaborative research efforts across multiple institutions can help validate the reliability and accuracy of stromal TILs as a biomarker and establish guidelines for personalized treatment strategies in early-stage TNBC patients.