Would you consider omitting platinum from neoadjuvant chemotherapy in women > 50 years of age with localized triple negative breast cancer?

I would not use the results cited above from the >50 subgroup (which was just 30% of their study population) of the study from the Tata Memorial Centre to justify omission of carboplatin from the neoadjuvant regimen for TNBC in otherwise healthy patients over 50 with TNBC. There is compelling data from BrighTNess, GeparSixto, and CALGB 40603 that the inclusion of carboplatin significantly improves the pCR rate, and from most of those trials, including Gupta et al., that this is associated with improvements in event-free survival. The standard for a fit patient in this age group should be the full KEYNOTE-522 regimen - with the addition of both carboplatin and, if available, pembrolizumab to weekly paclitaxel and AC. In fact, if I have an ol...

SABCS; Abstract GS5-01 2022 (page 4695 of the PDF) as presented by Dr. Gupta included 720 patients randomly assigned to receive paclitaxel alone (n = 355) or in combination with carboplatin (n = 365); followed by AC orEC, then standard surgery and radiotherapy. Based on subgroup analyses, the benefit of carboplatin was confined to patients younger than age 50; there seemed to be a significant interaction between treatment and age. In patients younger than age 50, the 5-year disease-free (74.5% vs. 62.3%; P = .003) and overall (76.8% vs. 65.7%; P = .003) survival rates were higher with carboplatin than without.

However, this study did not include immunotherapy, and in patients over 50 who would otherwise qualify for treatment ala KEYNOTE-522...