University of Kansas Medical Center, Westwood, KS
Priyanka Sharma , Claire Ward , Anne O'Dea , Marc Steven Hoffmann , Jennifer R. Klemp , Marilee McGinness , Jamie Lynn Wagner , Joshua Mammen , Amanda Leigh Amin , Carolyn Lehn , Roy A. Jensen , Andrew K. Godwin , Qamar J. Khan , Bruce F. Kimler
Background: Pathological complete response (pCR) in TNBC is associated with excellent long term survival. Recent studies demonstrate that addition of neoadjuvant (NA) carboplatin (Cb) to anthracycline/taxane chemotherapy improves pCR in TNBC. The prognostic value of pCR attained with anthracycline-free platinum/taxane chemotherapy in TNBC is not well known. Aims: To determine the long term outcomes in TNBC patients treated with NA Cb + Docetaxel (D). Methods: 443 patients with stage I (T>1cm), II, or III TNBC were enrolled in a prospective multisite registry between 2011-2015, out of which 76 patients received NA chemotherapy regimen of Cb(AUC 6) + D(75 mg/m2) q 21 days (4-6 cycles). pCR (no evidence of invasive tumor in the breast and axilla) and Residual Cancer Burden (RCB) was evaluated and patients were followed for recurrence and survival. Results: For the 76 eligible patients, median age: 52 yrs, African-American:16%, median tumor size: 3 cm, 33% LN positive and 25% with germline BRCA mutation. 88% of patients received 6 cycles of chemotherapy. pCR and RCB 0/1 rates were 66% (50/76) and 80% (61/76) respectively. Patients achieving pCR did not receive additional adjuvant chemotherapy. 73% of patients with RCB 2/3 received adjuvant chemotherapy. At a median follow up of 2.3 (range 0.5 - 7.8) years the RFS is 88% in the entire cohort. RFS is 95% and 76% in patients with and without pCR, respectively (HR: 0.14, p=0.014) and 94% and 68% in patients with RCB 0/1 and RCB 2/3 respectively (HR: 0.19, p=0.029). On univariate analysis higher stage, node positive status and lack of pCR were associated with a worse RFS. BRCA mutation status did not impact pCR or RFS Conclusions: NA CbD chemotherapy yields encouraging pCR rates (66%) in patients with TNBC; patients achieving pCR with this regimen demonstrate excellent RFS (95% at 2.3 years) without adjuvant anthracycline chemotherapy. The RFS of 76% in patients without pCR is consistent with known literature. For TNBC patients achieving pCR with NA CbD, adjuvant anthracycline can be avoided. Prospective studies to evaluate the efficacy of neoadjuvant platinum + taxane regimen in TNBC are needed.
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