BMC Cancer (Nov 2022)

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

DOI
https://doi.org/10.1186/s12885-022-10250-x
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 12

Abstract

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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.

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