What is the risk of recurrence of triple-negative breast cancer (TNBC) in a patient with stage I disease who has completed chemotherapy and radiation therapy with no evidence of disease?

From the Guidelines

The risk of recurrence for triple-negative breast cancer (TNBC) at stage 1 after completing chemotherapy and radiation with no evidence of disease is approximately 10-20% over the first five years, with the highest risk occurring in the first 2-3 years. Most recurrences in TNBC happen within the first 3-5 years after diagnosis, and after the 5-year mark, the risk decreases significantly, which differs from hormone receptor-positive breast cancers where recurrence risk can extend beyond 5 years 1.

Follow-up and Lifestyle Modifications

Regular follow-up is essential and typically includes:

• Clinical exams every 3-6 months for the first three years
• Every 6-12 months for years 4-5
• Annually thereafter 1 Annual mammograms are also recommended. Lifestyle modifications can potentially reduce recurrence risk, including:
• Maintaining a healthy weight
• Regular exercise (aim for 150 minutes of moderate activity weekly)
• Limiting alcohol consumption
• Eating a balanced diet rich in fruits and vegetables 1.

Treatment and Prognosis

While TNBC doesn't respond to hormone therapy or HER2-targeted treatments, ongoing clinical trials are exploring new maintenance therapies that might further reduce recurrence risk in the future. The prognosis of TNBC is generally poorer than other forms of breast cancer, with a higher risk of recurrence and mortality, especially in the first 5 years after diagnosis 1.

Key Considerations

It is essential to note that the risk of recurrence and mortality in TNBC can be influenced by various factors, including the patient's age, race, and family history of breast cancer. Therefore, a personalized approach to follow-up and treatment is crucial to optimize outcomes 1.

From the Research

Risk of Recurrence in Triple-Negative Breast Cancer

The risk of recurrence in triple-negative breast cancer (TNBC) is a significant concern, with studies indicating a high recurrence rate and poor outcomes 2, 3, 4, 5.

Factors Associated with Recurrence

Several factors are associated with an increased risk of recurrence in TNBC, including:

• Increasing tumor size 5
• Positive nodal status 5
• Increasing stage 5
• Type of chemotherapy (adjuvant vs neoadjuvant) 5
• Lack of targeted therapy 3, 5

Patterns of Recurrence

Patterns of recurrence in TNBC include:

• Isolated locoregional recurrence 5
• Isolated distant recurrence 5
• Both locoregional and distant recurrence 5
• Common sites of distant recurrence include lung, brain, bone, and liver 5

Treatment and Outcomes

Treatment for TNBC typically involves chemotherapy, with or without immunotherapy 3, 4, 6.

• Neoadjuvant chemotherapy can provide important prognostic information and guide adjuvant therapy decisions 4
• Adjuvant capecitabine may improve long-term outcomes in high-risk patients 4
• Emerging therapies, such as immune checkpoint inhibitors and anti-androgens, may offer new treatment options for TNBC 3, 4, 6

Disease-Free Survival and Overall Survival

Disease-free survival (DFS) and overall survival (OS) rates vary depending on the study and treatment regimen:

• A feasibility study of adjuvant enzalutamide in early-stage, AR-positive TNBC reported 1-year, 2-year, and 3-year DFS rates of 94%, 92%, and 80%, respectively 6
• Median OS has not been reached in some studies 6