Clinical cancer research : an official journal of the American Association for Cancer Research 2017-02-01
Efficacy of Neoadjuvant Carboplatin plus Docetaxel in Triple-Negative Breast Cancer: Combined Analysis of Two Cohorts.
Abstract
Purpose
Recent studies demonstrate that addition of neoadjuvant (NA) carboplatin to anthracycline/taxane chemotherapy improves pathologic complete response (pCR) in triple-negative breast cancer (TNBC). Effectiveness of anthracycline-free platinum combinations in TNBC is not well known. Here, we report efficacy of NA carboplatin + docetaxel (CbD) in TNBC.
Experimental design
The study population includes 190 patients with stage I-III TNBC treated uniformly on two independent prospective cohorts. All patients were prescribed NA chemotherapy regimen of carboplatin (AUC 6) + docetaxel (75 mg/m2) given every 21 days × 6 cycles. pCR (no evidence of invasive tumor in the breast and axilla) and residual cancer burden (RCB) were evaluated.
Results
Among 190 patients, median tumor size was 35 mm, 52% were lymph node positive, and 16% had germline BRCA1/2 mutation. The overall pCR and RCB 0 + 1 rates were 55% and 68%, respectively. pCRs in patients with BRCA-associated and wild-type TNBC were 59% and 56%, respectively (P = 0.83). On multivariable analysis, stage III disease was the only factor associated with a lower likelihood of achieving a pCR. Twenty-one percent and 7% of patients, respectively, experienced at least one grade 3 or 4 adverse event.
Conclusions
The CbD regimen was well tolerated and yielded high pCR rates in both BRCA-associated and wild-type TNBC. These results are comparable with pCR achieved with the addition of carboplatin to anthracycline-taxane chemotherapy. Our study adds to the existing data on the efficacy of platinum agents in TNBC and supports further exploration of the CbD regimen in randomized studies. Clin Cancer Res; 23(3); 649-57. ©2016 AACR.
Related Questions
Would you consider avoidance of AC and proceeding to surgery in a cT2N0 TNBC patient who achieves a significant clinical response to carboplatin, paclitaxel, and pembrolizumab as part of the KEYNOTE-522 regimen?
Full disclosure -- I trained in breast cancer at UCLA, where we generally avoid anthracyclines. The main downside of adding an anthracycline to a taxane-based regimen is the elevated risk of leukemia, myelodysplasia, and congestive heart failure or weakening of the heart long-term. I use neoadjuvant...
What treatment would you offer for a patient with unresectable triple negative breast CA who remains unresectable after completion of dd AC-T?
If the patient was responding to treatment but maybe presented with a large mass and had an insufficient response to chemo to convert her to resectability, further chemotherapy with carboplatin, preferably in combination with another agent - and I wouldn't rule out using docetaxel, given the activit...
Which systemic therapy (if any) do you offer premenopausal women with a second TNBC local resectable recurrence and an extensive chemotherapy history?
Patients with locoregional recurrence definitely benefit from repeated chemotherapy for sure (as shown in CALOR trial and our own experience). The question here is after exhausting anthracycline and taxane-based therapy as most patients would have been already, what might be the best regimen? The f...
How would you manage a patient with synchronous breast and ovarian cancer, s/p neoadjuvant chemotherapy and surgery for ER+/HER2- breast cancer and found to have an ER+ ovarian cancer nodal metastases at TAH/BSO?
I usually treat my triple negative breast cancer patients (whether or not there's a deleterious mutation in the homologous recombination repair pathway, e.g. BRCA1 or BRCA2) with neoadjuvant docetaxel + carboplatin. The addition of carboplatin to taxane-based neoadjuvant chemotherapy regimens was ev...
How do you manage therapy in an elderly, >80 years of age, patient with triple-negative breast cancer that is not a surgical candidate?
Treatment decisions for these patients can best be made based on geriatric assessment, estimated life expectancy, whether the treatment goal is prolonged survival or palliation, the potential benefits and toxicities of a specific treatment, and the patient’s personal goals for treatment. The number ...