Neoadjuvant chemotherapy in women with triple-negative breast cancer: Real world results from western Kenya
Hussain I Rangoonwala, Naftali Busakhala, Hillary Kiprono, Loice Sitienei, Erick Chesori, Katherine Niemeyer, Winnie Sabul, Jesse Opakas, Anne Ngelel, Felix Pabon- Rodriguez, Kibet Keitany, Elias Melly, Joanna Hunter-Squires, Kathy D Miller, Nicholas Kisilu, Patrick J Loehrer, Jennifer S MorganAbstract
Background
Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype for which neoadjuvant chemotherapy (NACT) is used for locally advanced (LA) disease. Patients with TNBC who experienced a pathologic complete response (pCR) following NACT have been found to have extended overall survival (OS) compared to patients with residual disease. Sparse data exists on the frequency and impact of pCR following NACT for TNBC in East Africa.
Methods
We retrospectively reviewed patients diagnosed with LA TNBC who received NACT between 2018 and 2022 at Moi Teaching and Referral Hospital in Eldoret, Kenya. After NACT, patients underwent mastectomy in which specimens were reviewed histologically as either pCR or residual disease in the breast and/or axilla. Clinical data were analyzed using descriptive statistics and Kaplan-Meier methods.
Results
Sixty-nine women with LA TNBC were included. Patient characteristics at diagnosis: Median age = 51 years (IQR 44-60); T4 disease = 34 (49%); and nodal involvement = 62(91%). Forty-six patients (67%) received anthracycline/taxane-based chemotherapy with a median of 8 cycles (IQR 6-8), and 47 (68%) underwent mastectomy, with only 7% achieving pCR. Assuming all lost-to-follow-ups died, the worst-case OS was 83% and 56% at 1 and 2 years, respectively.
Conclusions
In this LMIC setting, patients who presented with LA TNBC had lower pCR rates following NACT than observed in high-income countries. Our findings highlight the critical need for innovative, cost-effective programs focused on early detection of breast cancer, linkage of care, and delivery of more effective therapies to improve outcomes in the region.