Management of early-stage triple-negative breast cancer: recommendations of a panel of experts from the Brazilian Society of Mastology
Ruffo Freitas-Junior,
Vilmar Marques de Oliveira,
Antonio Luiz Frasson,
Francisco Pimentel Cavalcante,
Fabio Postiglione Mansani,
André Mattar,
Felipe Pereira Zerwes,
Adriana Magalhães de Oliveira Freitas,
Alessandra Borba Anton de Souza,
Andrea P. Damin,
Annamaria Massahud Rodrigues dos Santos,
Carlos Alberto Ruiz,
Clécio Ênio Murta de Lucena,
Eduardo Camargo Millen,
Fábio Bagnoli,
Felipe Andrade,
Frank Lane Braga Rodrigues,
Gil Facina,
Guilherme Novita,
Jose Luiz Pedrini,
José Pereira Guará,
Leonardo Ribeiro Soares,
Marcus Vinicius de Nigro Corpa,
Mauro Passos,
Nancy Cristina Ferraz de Lucena Ferreira,
Nilceana Maya Aires Freitas,
Rafael Henrique Szymanski Machado,
Roberto Kepler da Cunha Amaral,
Tomás Reinert,
Vinicius Milani Budel
Affiliations
Ruffo Freitas-Junior
Advanced Center for Breast Diagnosis (CORA), Federal University of Goiás and the Araújo Jorge Hospital, Goiás Association for the Combat of Cancer
Vilmar Marques de Oliveira
School of Medical Sciences, Santa Casa de Misericórdia de São Paulo
Antonio Luiz Frasson
Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (RS), Brazil and the Hospital Israelita Albert Einstein
Francisco Pimentel Cavalcante
Fortaleza General Hospital
Fabio Postiglione Mansani
Department of Medicine, State University of Ponta Grossa
André Mattar
Reference Center in Women’s Health Care, Pérola Byington Hospital
Felipe Pereira Zerwes
Pontifical Catholic University of Rio Grande do Sul
Adriana Magalhães de Oliveira Freitas
Larmony Clinic
Alessandra Borba Anton de Souza
Pontifical Catholic University of Rio Grande do Sul
Andrea P. Damin
Federal University of Rio Grande do Sul
Annamaria Massahud Rodrigues dos Santos
Santa Casa de Misericórdia de Belo Horizonte
Carlos Alberto Ruiz
Teaching Hospital, School of Medicine, University of São Paulo
Clécio Ênio Murta de Lucena
Federal University of Minas Gerais
Eduardo Camargo Millen
Oncoclínicas Institute
Fábio Bagnoli
School of Medical Sciences, Santa Casa de Misericórdia de São Paulo and the Hospital Israelita Albert Einstein
Felipe Andrade
Department of Breast Surgery, Hospital Sírio-Libanês
Frank Lane Braga Rodrigues
Institute of Mastology and Oncology and the Goiania Institute of Hematology (INGOH)
Gil Facina
Department of Gynecology, Federal University of São Paulo
Guilherme Novita
Hospital Israelita Albert Einstein
Jose Luiz Pedrini
Nossa Senhora da Conceição Hospital
José Pereira Guará
Teaching Hospital of the Federal University of Maranhão
Leonardo Ribeiro Soares
Advanced Center for Breast Diagnosis (CORA), Federal University of Goiás and the Dona Iris Women’s and Maternity Hospital
Marcus Vinicius de Nigro Corpa
Department of Pathology, Hospital Israelita Albert Einstein
Mauro Passos
Hospital de Base
Nancy Cristina Ferraz de Lucena Ferreira
Barão de Lucena Hospital, Federal University of Pernambuco
Nilceana Maya Aires Freitas
Radiotherapy Unit, Araújo Jorge Cancer Hospital, Goiás Association for the Combat of Cancer, and Brazilian Center for Radiotherapy, Oncology and Mastology (CEBROM)
Rafael Henrique Szymanski Machado
Hospital Federal da Lagoa
Roberto Kepler da Cunha Amaral
Grupo CAM / Oncoclínicas
Tomás Reinert
Oncoclínicas Porto Alegre, Porto Alegre (RS) and the Serra Gaúcha Research Center
Vinicius Milani Budel
Teaching Hospital of the Federal University of Paraná
Abstract Background Triple-negative breast cancer (TNBC) is a heterogenous subtype involving different patterns of behavior and clinical course, demanding a complex, individualized sequence of treatment. The knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology regarding TNBC were evaluated and a consensus regarding management and treatment was reached. Methods Affiliates completed a survey involving 44 objective questions. In addition, a specialist meeting was held with 27 experts and 3 ad hoc consultants. The panelists completed the survey before and after brainstorming. Answers achieving 70% of agreement were considered consensual. The chi-square test was used to compare answers between panelists and affiliates and the Kappa coefficient to calculate agreement. Results Consensus among the panelists increased from 26 (59.1%) to 32 questions (72.7%) following brainstorming (p = 0.17), including 7/10 questions on systemic treatment. Among the affiliates, consensus was achieved for 24 questions (54.5%), resulting in moderate agreement (κ = 0.445). Neoadjuvant chemotherapy should be indicated for almost all cases (except cT1a-b N0) and should include platinum agents. When indicated, immunotherapy is part of the standard of care. The panel reaffirmed the concept of no ink on tumor as indicative of adequate margins and the possibility of sentinel lymph node biopsy for cN1 patients who become cN0 following neoadjuvant therapy. Controversies remain on combining immunotherapy with capecitabine/olaparib in pertinent cases. Conclusion Expert consensus was achieved for > 70% of the questions, with moderate agreement between panelists and affiliates. Educational interventions on systemic breast cancer treatment affected decision-making in 60% of the questions.
