An Audit of Triple-Negative Breast Cancer (TNBC) Management at a Tertiary Breast Cancer Care Center in India

Abstract

Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype with few options for targeted therapy. Neoadjuvant chemotherapy (NACT) is recommended as the first line of therapy in TNBC treatment to improve survival outcomes. The acceptance of NACT in Indian practice is lower than that of global standards. Here, we audit the management of TNBC in a single surgeon unit by evaluating the rate of NACT uptake and its association with survival outcomes. This single institutional audit focuses on the management and outcomes of 165 TNBC patients of Indian origin. Overall, 57% underwent upfront surgery, and 43% received NACT. Early-stage patients showed better disease-free survival (DFS) and overall survival (OS) than those diagnosed at late stages. The proportion of patients with NACT was higher among the late-stage patients (70.3%). Most patients, regardless of treatment modality, received breast-conserving surgery. Post-NACT breast conservation consisted of a high percentage of oncoplastic interventions. Late-stage patients who received NACT and achieved a complete pathological response exhibited survival outcomes comparable to those patients diagnosed at early stage. Conversely, patients who did not respond to NACT, i.e., those with residual disease, experienced markedly poorer survival outcomes, underscoring the critical impact of NACT responsiveness on prognosis in advanced-stage TNBC. The stage at diagnosis and response to NACT treatment, if presenting late, are critical prognostic indicators for TNBC patients. Efforts for early diagnosis and wider acceptance of NACT as an option in TNBC treatment in India could lead to better outcomes.