ArticleBreast cancer research and treatment2026
Early first-line systemic anticancer therapeutic attrition after metastatic recurrence in triple-negative breast cancer following neoadjuvant chemo-immunotherapy: a multicenter real-world study.
Article in Breast cancer research and treatment, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo assess the incidence and determinants of early first-line systemic anticancer therapeutic attrition after metastatic recurrence in triple-negative breast cancer (TNBC) treated with neoadjuvant chemo-immunotherapy.
methodsWe conducted a retrospective multicenter analysis of 209 consecutive patients with early-stage TNBC treated with neoadjuvant chemo-immunotherapy. After a median follow-up of 24 months, 54 developed metastatic recurrence. Early first-line systemic anticancer therapeutic attrition was defined as failure to initiate systemic anticancer therapy within 90 days of documented recurrence. Associations were evaluated using univariate and multivariable logistic regression.
resultsAmong patients who developed metastatic recurrence, 17 of 54 evaluable patients (32.7%) experienced early first-line systemic anticancer therapeutic attrition. Patients who did not initiate treatment had a significantly shorter disease-free interval compared with those who received first-line therapy (median 7.4 vs. 14.3 months; p = 0.011). PD-L1 positivity was more frequent in the attrition group (64.7% vs. 28.6%; p = 0.021), and central nervous system metastases were more commonly observed (41.2% vs. 20.0%). Median overall survival from metastatic recurrence was 3.4 months in the attrition group compared with 12.4 months in the no-attrition group. In multivariable analysis, shorter disease-free interval (OR 0.87 per month; 95% CI 0.78-0.97), PD-L1 positivity (OR 8.73; 95% CI 1.81-42.04), and presence of central nervous system metastases (OR 7.09; 95% CI 1.41-35.57) were independently associated with early first-line therapeutic attrition.
conclusionIn this real-world multicenter cohort, nearly one-third of patients with TNBC experiencing metastatic recurrence after neoadjuvant chemo-immunotherapy did not initiate first-line systemic therapy within a clinically relevant timeframe. Early first-line systemic anticancer therapeutic attrition represents a meaningful gap in the care continuum and warrants improved surveillance and multidisciplinary management strategies. CLINICAL TRIAL NUMBER: Not applicable.
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