Pathologic complete response (pCR) to neoadjuvant treatment (NAT) with carboplatin, nab-paclitaxel and anthracycline in early and locally advanced triple-negative breast cancer (TNBC).

Authors

null

Isabel Miras

Medical Oncology Department, University Hospital Virgen del Rocío, Sevilla, Spain

Isabel Miras , Ana Gil , Paloma Santos-Fernandez , Alberto Sánchez-Camacho , Alejandro Falcon Gonzalez , Marta Benavent , Mónica Cejuela Solís , Salvador Bofill , Sandra Flores , Manuel Ruiz-Borrego

Organizations

Medical Oncology Department, University Hospital Virgen del Rocío, Sevilla, Spain, Medical Oncology Department, University Hospital Puerto Real, Cádiz, Spain, Medical Oncology Department, University Hospital Virgen Macarena, Sevilla, Spain, University Hospital Virgen del Rocío, Sevilla, Spain, Hospital Virgen del Rocio de Sevilla. GEICAM Spanish Breast Cancer Group, Seville, Spain

Research Funding

No funding received
None.

Background: Achieving a pCR (absence of residual invasive disease in breast and measurable disease in any of the axillary nodes sampled, ypT0/is and ypN0) after NAT correlates with improved survival. TNBC phenotype have a poor prognosis. However, it is associated with higher NAT response rates. With traditional schemes based on anthracyclines and taxanes, pCR rates of around 25-40% are obtained. Different schemes have been studied providing an increase in pCR such as using nab-paclitaxel, platinum salts, bevacizumab or dose dense (dd) anthracyclines. The purpose of the present study is to explore feasibility, toxicity and pCR of new aproach with carboplatine, nab-paclitaxel and antracycline in TNBC. Methods: Retrospective study with early and locally advanced TNBC pts, ECOG 0-1, without contraindications to antracyclines, were included. Treatment consisted of carboplatine AUC2 with nab-paclitaxel 80 mg/m2 i.v. weekly for 12 doses followed by epirubicin 90 mg/m2 (elderly pts recieved at 75 mg/m2) with cyclophosphamide 600 mg/m2 i.v., every 2 weeks (dd) or 3 weeks (if pts had G3-4 toxicity) for 4 doses. G-CSF support was allowed in pts with neutropenia G3-4. Pts with residual disease after NAT were offered capecitabine as adjuvant treatment. The primary endpoint was pCR. Results: From 02/2018 to 06/2022, 96 pts was included. Median age was 53 years (27-78). Clinical stage was I in 16 pts, II in 50 pts and III in 30 pts (N+ in 40'6%). 98% pts had tumours with a Ki67 20% or higher. 36’5% pts was premenopausal. 10 pts were germline BRCA mutated (8/10 gBRCA1, 2/10 gBRCA2) 50/96 pts (55’2%) had dd epirubicin-cyclophospamide (EC) and 44’8% pts recieved EC every 3 weeks (for G3 adverse events (AE)). pCR in pts who had dd treatment was 65’4% and 40’9% in pts with EC non-dd (p 0’016). 89’9% pts with residual disease completed adjuvant treatment with 8 cycles of capecitabine. 53/96 pts had an AE related with NAT. Neutropenia G3-4 (45’5% pts, all of them recieved dd treatment) and any grade of alopecia and mucositis (60% and 25% respectively) were the most frecuent AE reported. Pts with neutropenia G3-4 on blood test recieved G-CSF in subsequent cycles with resolution of haematological AE. All pts with dd treatment recieved G-CSF. One patient had a disease progression by radiological evaluation during the treatment. During follow-up 9 pts relapsed (1 had a pCR with NAT) and 5 pts died for progression disease. Conclusions: NAT on TNBC pts with carboplatine, nab-paclitaxel and antracycline dd is a feasible, safe and highly effective option. Even though survival analysis is not yet mature in our study, pCR has been shown to be a surrogate for overall survival. The excellent results obtained with this scheme, make it a good treatment option and could be an alternative to pembrolizumab (Keynote-522) in pts with autoinmmune diseases or immune-AE due to similar pCR.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Breast Cancer—Local/Regional/Adjuvant

Track

Breast Cancer

Sub Track

Neoadjuvant Therapy

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e12608)

DOI

10.1200/JCO.2023.41.16_suppl.e12608

Abstract #

e12608

Abstract Disclosures