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Purpose <p>To 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.</p> Methods <p>We 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.</p> Results <p>Among 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; <i>p</i> = 0.011). PD-L1 positivity was more frequent in the attrition group (64.7% vs. 28.6%; <i>p</i> = 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.</p> Conclusion <p>In 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.</p> Clinical trial number <p>Not applicable.</p>

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Early first-line systemic anticancer therapeutic attrition after metastatic recurrence in triple-negative breast cancer following neoadjuvant chemo-immunotherapy: a multicenter real-world study

  • 期刊论文

  • 发表日期：

    2026年7月10日

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  • Palma Fedele,
  • Alessandro Rizzo,
  • Matteo Landriscina,
  • Luigia Stefania Stucci,
  • Carmela Inneo,
  • Maria Morritti,
  • Franco Morelli,
  • Francesco Giuliani,
  • Lucia Moraca,
  • Giuseppe Cairo,
  • Marianna Giampaglia,
  • Beatrice Tedesco,
  • Assunta Melaccio,
  • Felicia M. Maselli,
  • Antonio Gnoni,
  • Antonella Licchetta,
  • Federica Fumai,
  • Elsa Vitale,
  • Fiorella Restaino Marino,
  • Emanuela Zifarone,
  • Laura Lanotte,
  • Raffaele Ardito,
  • Gennaro Gadaleta-Caldarola

摘要

Purpose

To 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.

Methods

We 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.

Results

Among 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.

Conclusion

In 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.