Platinum Plus Standard Neoadjuvant Chemotherapy for Triple-Negative Breast Cancer

By: Julia Fiederlein Cipriano
Posted: Wednesday, January 18, 2023

According to Sudeep Gupta, MD, DM, of the Tata Memorial Hospital, Mumbai, India, and colleagues, the addition of platinum to standard neoadjuvant chemotherapy resulted in improvements in disease-free and overall survival in young patients with triple-negative breast cancer. The results of a phase III trial, which were presented during the 2022 San Antonio Breast Cancer Symposium (SABCS; Abstract GS5-01), suggested this regimen should be the standard of care.

A total of 720 patients were randomly assigned to receive paclitaxel alone (n = 355) or in combination with carboplatin (n = 365); both regimens were followed by doxorubicin or epirubicin plus cyclophosphamide. Upon completion of the regimens, the patients underwent standard surgery and radiotherapy. 

At a median follow-up of 67.6 months, in patients treated with and without carboplatin, the 5-year disease-free survival rates were 70.6% and 64.5% (hazard ratio [HR] = 0.79; P = .073); the 5-year overall survival rates were 74.0% and 66.7% (HR = 0.75; P = .034); and the pathologic complete response rates were 55.2% and 41.5% (P = .0004), respectively. 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. After the investigators adjusted for baseline clinical tumor size and age, the addition of carboplatin seemed to result in significant improvements in overall survival (HR = 0.75; P = .038).

A total of 38.5% and 30.1% of patients treated with and without carboplatin, respectively, experienced a toxicity of grade 3 or higher (P = .02). Neutropenia and thrombocytopenia of grade 3 or higher, as well as febrile neutropenia, were reported more frequently with carboplatin than without it.

Disclosure: The study authors reported no conflicts of interest.

2022 San Antonio Breast Cancer Symposium

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