Journal: Annals of surgical oncology
Study type and data source
Multicenter retrospective cohort study using the U.S. National Cancer Database, including 56,606 adult women with nonmetastatic triple‑negative breast cancer treated with neoadjuvant systemic therapy from 2012–2022. Patients were grouped by age (<50, 50–70, >70 years) and by receipt of neoadjuvant chemotherapy alone versus chemoimmunotherapy.
Key findings
1. Utilization trends
- • Use of neoadjuvant chemoimmunotherapy (NACI) increased substantially over the decade, with a corresponding decline in chemotherapy alone (NAC).
- • Despite this, women older than 70 years were less likely than younger patients to receive NACI in contemporary years.
2. Pathologic complete response (pCR)
- • Across the entire cohort, NACI produced higher pCR rates in both breast and axillary nodes compared with NAC (relative risk 1.405, p < 0.0001).
- • The relative pCR benefit with NACI was largest in women >70 years (relative risk 1.56, p < 0.0001), indicating particularly strong tumor response in this older group.
3. Overall survival (OS)
- • NACI was associated with better overall survival compared with NAC for all women (hazard ratio 0.704, p < 0.0001).
- • The survival advantage was most pronounced in the 50–70-year age group, though benefit was seen across age strata.
Clinical implications
- • In real‑world practice, neoadjuvant chemoimmunotherapy is increasingly adopted for triple‑negative breast cancer and is associated with higher pCR and improved overall survival compared with chemotherapy alone.
- • Older patients, particularly those >70 years, appear to derive substantial benefit in pCR yet remain under-treated with immunotherapy.
- • These data support offering neoadjuvant chemoimmunotherapy to appropriately selected older adults with triple‑negative breast cancer, rather than excluding them solely on the basis of age.