Survival outcomes for dose‐dense paclitaxel plus carboplatin neoadjuvant vs standard adjuvant chemotherapy in stage II to III triple‐negative breast cancer: A prospective cohort study with propensity‐matched analysis. Issue 4 (19th April 2022)

• Record Type: Journal Article
• Authors: Xiu, Meng; Zhang, Pin; Wang, Xiang; Fan, Ying; Li, Qiao; Li, Qing; Wang, Jiayu; Dong, Lin; Luo, Yang; Yuan, Peng; Ma, Fei; Xu, Binghe
• Is Part Of: International journal of cancer. Volume 151:Issue 4(2022)
• Page Start: 578
• Page End: 589
• Publication Date: 2022-04-19
• Subjects: dose‐dense chemotherapy -- neoadjuvant chemotherapy -- platinum -- survival -- triple‐negative breast cancer; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.34022
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: There is a scarcity of data exploring the long‐term benefits of platinum‐based (anthracycline‐free) neoadjuvant chemotherapy (NACT) for triple‐negative breast cancer (TNBC). The prospective cohort study was conducted at Cancer Hospital, Chinese Academy of Medical Sciences. Patients with TNBC in stage II‐III were enrolled to receive NACT of dose‐dense (dd) paclitaxel (175 mg/m 2 ) plus carboplatin (AUC 4.0) biweekly (ddPCb) for 6 cycles, and matched patients during the same period who received standard adjuvant chemotherapy for survival comparison. From January 2014 to July 2021, 264 patients were included in the primary nonmatched analysis (neoadjuvant 99, adjuvant 165). Compared to those in the adjuvant group, patients receiving NACT had larger tumors, higher degrees of nodal burden and more advanced disease ( P < .001). Almost all patients in the adjuvant group received epirubicin plus cyclophosphamide followed by paclitaxel. Within a median follow‐up of 44.9 months, the 4‐year recurrence‐free survival (RFS, 82.6% vs 75.4%) and overall survival (OS, 86.6% vs 80.5%) were higher for patients in the neoadjuvant group without statistical difference. In the matched cohort of 134 patients (67 pairs), the 4‐year RFS (84.9% vs 60.9%; hazard ratio [HR], 0.32; 95% confidence interval [CI], 0.15‐0.69; P = .003) and OS (88.0% vs 65.9%, HR, 0.30, 95% CI, 0.12‐0.75, P = .010) were significantly superior for platinum‐based neoadjuvant than standard adjuvant chemotherapy. Compared to standard chemotherapy, ddPCb was related to less neutropenia and more thrombocytopenia. These results support the consideration of ddPCb as NACT for TNBC in stage II‐III. Randomized data and predictive biomarkers for platinum‐based chemotherapy are needed to be further investigated. Abstract : What's new? Evidence for the long‐term outcomes of platinum‐based (anthracycline‐free) neoadjuvant chemotherapy for triple‐negative breast cancer remains scarce. In this prospective study conducted among stage II‐III triple‐negative breast cancer patients, patients who received neoadjuvant chemotherapy with dose‐dense paclitaxel plus carboplatin (ddPCb) had a significantly better recurrence‐free survival and overall survival, compared to the matched cohort receiving standard adjuvant chemotherapy. Moreover, ddPCb was related to less neutropenia and more thrombocytopenia. Altogether, the findings support the consideration of platinum‐based neoadjuvant chemotherapy for promising survival benefits, and the ddPCb regimen is emerging as an innovative and well‐tolerated option.