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Adding carboplatin to standard neoadjuvant chemotherapy improves outcomes in patients with triple-negative breast cancer (TNBC), according to research presented at the San Antonio Breast Cancer Symposium 2022.
Researchers observed improvements in event-free survival (EFS) and overall survival (OS) with the addition of carboplatin, but these benefits were limited to patients who were 50 years of age or younger.
These results suggest that adding carboplatin to taxane-anthracycline neoadjuvant chemotherapy should be the standard treatment in patients with TNBC who are 50 years of age or younger, said study presenter Sudeep Gupta, MD, of Tata Memorial Centre in Mumbai, India. Dr Gupta and colleagues conducted this phase 3 trial to evaluate the efficacy and safety of adding carboplatin to standard sequential taxane-anthracycline neoadjuvant chemotherapy in patients with TNBC who had no evidence of metastatic disease.
The study included 717 patients. The median age was 46 years (range, 25-69). Most patients were 50 years of age or younger (69.7%), were pre- or peri-menopausal (58.3%), had locally advanced disease (60.3%), and had node-positive disease (88.8%). The patients were randomly assigned to receive standard sequential taxane-anthracycline neoadjuvant chemotherapy alone (n=356) or in combination with carboplatin (n=361).
In the control arm, patients received paclitaxel (100mg/m2) once weekly for 8 weeks, then doxorubicin (60mg/m2) or epirubicin (90mg/m2) plus cyclophosphamide (600mg/m2) once every 2 or 3 weeks for 4 cycles. Patients in the carboplatin arm received this regimen in combination with carboplatin (AUC-2) once weekly for 8 weeks. After chemotherapy, patients underwent surgery, which was followed by radiotherapy.
The pathologic complete response (pCR) rate was 54.5% in the carboplatin arm and 40.3% in the control arm (P <.001). Among patients age 50 or younger, the pCR rate was 61.0% in the carboplatin arm and 41.5% in the control arm (P <.001). Among patients older than 50 years, the pCR rates were 38.1% and 37.5%, respectively (P =1.0).
The median follow-up was 67.6 months. The 5-year EFS and OS rates were significantly higher with carboplatin among patients 50 years and younger, but there was no significant difference in EFS or OS rates between the treatment arms for patients older than 50 years of age.
In the younger cohort, the 5-year EFS rate was 74.2% in the carboplatin arm and 61.7% in the control arm (hazard ratio [HR], 0.642; 95% CI, 0.473-0.871; P =.004). In the older cohort, the 5-year EFS rate was 62.0% in the carboplatin arm and 69.3% in the control arm (HR, 1.309; 95% CI, 0.825-2.076; P =.253).
In the younger cohort, the 5-year OS rate was 77.1% in the carboplatin arm and 65.9% in the control arm (HR, 0.611; 95% CI, 0.440-0.848; P =.003). In the older cohort, the 5-year OS rate was 68.0% in the carboplatin arm and 68.9% in the control arm (HR, 1.132; 95% CI, 0.698-1.835; P =.615). Rates of grade 3 or higher hematologic adverse events (AEs) were higher in the carboplatin arm than in the control arm. This included neutropenia (8.6% vs 2.0%), anemia (1.9% vs 0.3%), thrombocytopenia (1.9% vs 0%), and febrile neutropenia (4.4% vs 2.8%). Rates of grade 3 or higher nonhematologic AEs were similar.
Serious AEs occurred in 14.7% of patients in the carboplatin arm and 12.9% of patients in the control arm.
Reference
Gupta S, Nair NS, Hawaldar R, et al. Addition of platinum to sequential taxane-anthracycline neoadjuvant chemotherapy in patients with triple-negative breast cancer: A phase III randomized controlled trial. Presented at SABCS 2022. December 6-10, 2022. Abstract GS5-01.
This article originally appeared on Cancer Therapy Advisor.
This article originally appeared on Cancer Therapy Advisor
