Anthracycline-Free Neoadjuvant Chemotherapy Ensures Higher Rates of Pathologic Complete Response in Breast Cancer.

Abstract

PURPOSE:

Neoadjuvant chemotherapy (NCT) is a standard of care for locally advanced and initially inoperable breast cancer. NCT can test chemotherapy efficacy and can be followed by breast-conserving surgery. Considering taxanes as one of the most effective agents, we analyzed the efficacy of a neoadjuvant schedule without anthracyclines and based only on taxanes and carboplatin, trying to avoid cardiotoxicity, which is the most serious side effect correlated with anthracyclines.

PATIENTS AND METHODS:

We enrolled 61 patients with breast cancer, belonging to 4 subgroups, according to molecular phenotypes: 24 triple-negative/basal-like, 13 HER2-like, 20 luminal B, and 4 luminal A. All patients underwent weekly chemotherapy with carboplatin AUC2, paclitaxel 80 mg/m2, with trastuzumab (in case of HER2 positivity) 2 mg/kg, except for luminal A patients, who underwent only hormonal therapy. Among 61 patients, 26 (43%) received modified radical mastectomy and 35 (57%) received breast-conserving surgery.

RESULTS:

The patients obtaining pathologic complete response (pCR) were 20 (83%) of 24 triple-negative/basal-like, 10 (76%) of 13 HER2-like, 6 (30%) of 20 luminal B, and 3 (75%) of 4 luminal A. All the patients were evaluated for toxicity: no grade 4 was detected, 5 patients experienced grade 3 neuropathy, then reverted to G2 after chemotherapy discontinuation. At a minimum follow-up of 5 years, median overall survival was 48 months.

CONCLUSION:

Taxane/carboplatin-based/anthracycline-free NCT is the best treatment for inoperable breast cancer in terms of efficacy and toxicity, because this approach avoids cardiotoxicity and obtains an optimal rate (64%) of pCR, with an important impact on survival.

• Authors: Francesca De Iuliis, Gerardo Salerno, Raffaella Corvino, Debora D'Aniello, Katia Cefalì, Ludovica Taglieri, Rosina Lanza, Susanna Scarpa
• Journal: Clinical breast cancer (Clin Breast Cancer) Vol. 17 Issue 1 Pg. 34-40 (02 2017) ISSN: 1938-0666 [Electronic] United States
• PMID: 27435626 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Anthracyclines
• Carboplatin
• Trastuzumab
• Paclitaxel

Topics

• Anthracyclines (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Breast Neoplasms (drug therapy, pathology)
• Carboplatin (administration & dosage)
• Case-Control Studies
• Chemotherapy, Adjuvant
• Female
• Follow-Up Studies
• Humans
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Staging
• Paclitaxel (administration & dosage)
• Prognosis
• Prospective Studies
• Survival Rate
• Trastuzumab (administration & dosage)