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Tumor-infiltrating lymphocytes predicted outcomes in triple-negative breast cancer

Issue: November 25, 2014

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Stromal lymphocytic infiltration significantly and independently predicted outcomes in patients with triple-negative breast cancer treated with adjuvant chemotherapy, according to an analysis of data from two randomized phase 3 trials.

Sylvia Adams, MD, assistant professor of medicine at New York University Cancer Institute, and colleagues evaluated 506 tumors for density of tumor-infiltrating lymphocytes (TILs) in intraepithelial and stromal compartments. The tumors were randomly selected from the ECOG E2197 and E1199 trials based on availability of sections.

Sylvia Adams

DFS served as the primary outcome measure. OS and distant recurrence-free interval served as secondary outcome measures.

Most of the 481 evaluable cancers has stromal TILs (80%), whereas 15% had intraepithelial TILs.

Median follow-up was 10.6 years. Researchers found that higher stromal TILs scores were associated with a better overall prognosis. Specifically, every 10% increase in stromal TILs correlated with a 19% decreased risk for death (P=.01), an 18% decreased risk for distant recurrence (P=.04), and a 14% decreased risk for recurrence or death (P=.02).

Multivariable analysis showed stromal TILs were independent prognostic markers of DFS, distant recurrence-free interval and OS.

“Although at present, the clinical utility of TILs in the day-to-day management of primary triple-negative breast cancers is limited, TILs could be useful for stratification in future clinical trials enrolling patients with triple-negative breast cancers once the evaluation method has been standardized,” Sherene Loi, MD, PhD, of Peter MacCallum Cancer Centre in Australia, wrote in an accompanying editorial. “The challenge ahead is to determine if TILs per se or a specific immune marker will be predictive for benefit with T-cell checkpoint inhibitors and how to successfully modulate immunity to reduce mortality from triple-negative breast cancers.”

For more information:

• Adams S. J Clin Oncol. 2014;doi:10.1200/JCO.2013.55.0491.
• Loi S. J Clin Oncol. 2014;doi:0.1200/JCO.2014.56.7677.

Disclosure: The researchers report no relevant financial disclosures.