Efficacy of neoadjuvant carboplatin/docetaxel chemotherapy in sporadic and BRCA-associated triple-negative breast cancer (TNBC).

Breast Cancer - Triple-Negative/Cytotoxics/Local Therapy
Session Type and Session Title: 
Poster Highlights Session, Breast Cancer - Triple-Negative/Cytotoxics/Local Therapy
Abstract Number: 
J Clin Oncol 32:5s, 2014 (suppl; abstr 1022)
Priyanka Sharma, Shane R. Stecklein, Bruce F. Kimler, Qamar J. Khan, Carol Sue Connor, Marilee McGinness, Joshua Mammen, Jamie Lynn Wagner, Roy A. Jensen, Andrew K. Godwin, Carol J. Fabian; University of Kansas Medical Center, Westwood, KS; University of Kansas Cancer Center, Kansas City, KS; University of Kansas Medical Center, Kansas City, KS; The University of Kansas Medical Center, Kansas City, KS

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Abstract Disclosures


Background: Recent studies demonstrate that addition of carboplatin to anthracycline/taxane chemotherapy improves pathological complete response (pCR) in TNBC. In vitro data exhibits synergy between platinum compunds and taxanes in TNBC. Efficacy of anthracycline-devoid neoadjuvant platinum/taxane combination in sporadic and BRCA-associated TNBC is not well known. Aim: To evaluate the efficacy of neoadjuvant Carboplatin/Docetaxel in sporadic and BRCA-associated TNBC utilizing clinical and BRCA mutation data from a prospective registry. Methods: 205 patients with stage I (T>1cm) II or III TNBC were enrolled in a prospective multisite registry between 2011-2013, out of which 42 patients received neoadjuvant chemotherapy regimen of Carboplatin AUC 6 + Docetaxel 75 mg/m2every 21 D (4-6 cycles). Following neoadjuvant therapy, all patients underwent breast surgery. pCR (no evidence of invasive tumor in the breast and axilla) and Residual Cancer Burden(RCB) was evaluated. RCB of 0 or1 was designated as near pCR (pCRn). All patients underwent comprehensive BRACAnalysis (Myriad). Results: For the 42 eligible patients, median age was 51 years (range 27-80), 19%: African-American and 57%: postmenopausal. Median tumor size was 3 cm and 33% LN positive. 90% of patients received 6 and 10% received 4 cycles of chemotherapy. The overall pCR and pCRn rates were 62% and 74%, respectively. 33% (14/42) of patients carried deleterious BRCA mutation (11 BRCA1, 3 BRCA2). For BRCAmutation carriers, both pCR and pCRn rates were 86%(12/14). For sporadic TNBC (N=28), pCR and pCRn rates were 50% and 68%, respectively. Tumor size, LN status, age and number of cycles of chemotherapy did not impact pCR rate. pCR was higher in BRCA mutation carriers compared to sporadic TNBC (p=0.04). Conclusions: We report very encouraging near pathologic response in both sporadic (68%) and BRCA-associated (86%)TNBC with a neoadjuvant platinum/taxane chemotherapy regimen. This Carboplatin/Docetaxel combination yielded pCR rates similar to observed rates with A/C plus Carboplatin however, is devoid of potential cardiac and secondary leukemia side effects and should be explored further in randomized studies.