Clinical cancer research : an official journal of the American Association for Cancer Research 2018-12-01
Pathological Response and Survival in Triple-Negative Breast Cancer Following Neoadjuvant Carboplatin plus Docetaxel.
ABSTRACT
PURPOSE
Prognostic value of pathologic complete response (pCR) and extent of pathologic response attained with anthracycline-free platinum plus taxane neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC) is unknown. We report recurrence-free survival (RFS) and overall survival (OS) according to degree of pathologic response in patients treated with carboplatin plus docetaxel NAC.
PATIENTS AND METHODS
One-hundred and ninety patients with stage I-III TNBC were treated with neoadjuvant carboplatin (AUC6) plus docetaxel (75 mg/m) every 21 days × 6 cycles. pCR (no evidence of invasive tumor in breast and axilla) and Residual cancer burden (RCB) were evaluated. Patients were followed for recurrence and survival. Extent of pathologic response was associated with RFS and OS using the Kaplan-Meier method.
RESULTS
Median age was 51 years, and 52% were node-positive. pCR and RCB I rates were 55% and 13%, respectively. Five percent of pCR patients, 0% of RCB I patients, and 58% of RCB II/III patients received adjuvant anthracyclines. Three-year RFS and OS were 79% and 87%, respectively. Three-year RFS was 90% in patients with pCR and 66% in those without pCR [HR = 0.30; 95% confidence interval (CI), 0.14-0.62; = 0.0001]. Three-year OS was 94% in patients with pCR and 79% in those without pCR (HR = 0.25; 95% CI, 0.10-0.63; = 0.001). Patients with RCB I demonstrated 3-year RFS (93%) and OS (100%) similar to those with pCR. On multivariable analysis, higher tumor stage, node positivity, and RCB II/III were associated with worse RFS.
CONCLUSIONS
Neoadjuvant carboplatin plus docetaxel yields encouraging efficacy in TNBC. Patients achieving pCR or RCB I with this regimen demonstrate excellent 3-year RFS and OS without adjuvant anthracycline.
Related Questions
New answer by Medical Oncologist at H Lee Moffitt Cancer Center, University of South Florida (July 8, 2019)
The data from the PROGECT study using neoadjvuant carboplatin/docetaxel in TNBC suggests that they do well when they attain a pCR without giving an anthracycline. (S...
Given the data from KEYNOTE-522, would you try to incorporate chemotherapy in the treatment regimen?
New comment by Medical Oncologist at Cancer Treatmt Center of America ( December 13, 2020)
I agree that there is also data in using a platinum with a taxane or TC regimen in adjuvant setting.
She is 7 years out so should be okay to using a taxane again.
If no anthracycline, what alternative regimen would you consider?
New answer by Medical Oncologist at St. Luke's Episcopal Hospital (March 5, 2021)
There is considerable variability in cardiac tolerance of Doxorubicin. Whereas the cumulative dose limit is 450 mg/m2 (it used to be 550 mg/m2) when the drug was first markete...
Assume normal cardiac function and no obvious co-morbidities. No anthracycline previously due to age alone. The patient’s BRCA status is unknown...
New comment by Medical Oncologist at H Lee Moffitt Cancer Center, University of South Florida ( February 10, 2022)
CREATE-X did but the number of TC-treated patients was less than 20 patients in each arm. Over 96% of the patients got anthracyclines so it couldn't really tell you much about...