Neoadjuvant nab-paclitaxel with carboplatin may benefit patients with triple-negative breast cancer
A regimen of neoadjuvant nab-paclitaxel with carboplatin may be an effective anthracycline-free treatment with an acceptable pathological complete response rate among triple negative breast cancer patients with BCRA1/2 mutations, according to research presented at ASCO 2021.
During the presentation, Lisa Katharina Richters, MD, of the Center for Familial Breast and Ovarian Cancer at the University of Cologne, Cologne, Germany, explained that “the optimal treatment for early triple negative breast cancer has yet to be determined. To address this issue, the West German Study Group performed the ADAPT-TN phase 2 trial.”
Richters and colleagues assessed data from patients in the ADAPT-TN trial who received 12 weeks of neoadjuvant nab-paclitaxel with carboplatin or gemcitabine. They analyzed the distribution of tumor mutations in genes associated with breast cancer and the effect of BCRA status on pathological complete response (pCR) along with other outcomes, including invasive disease-free survival, overall survival and distant disease-free survival.
Researchers used a customized gene panel to complete next generation sequencing-based analysis of BRCA1/2 and 18 genes potentially associated with breast cancer using DNA from pretreatment samples.
A total of 266 samples were analyzed successfully, with 42 samples — 28 from patients who received gemcitabine and 14 form those who received carboplatin — identified with one or more deleterious BRCA1/2 variant. There was no deleterious mutation identified in 8.3% of samples.
They determined that overall, patients with BRCA1/2 mutations had a 45.2% pCR, compared with a 34.4% pCR among those who did not have a mutation.
In patients with a BRCA1/2 mutation who were receiving carboplatin, the pCR was 64.3%, compared with 34.5% pCR in all other patients (OR = 3.41; 95% CI, 1.11-10.5).
In a direct comparison to BRCA1/2 patients who received gem, the researchers did not identify a statistically significant difference in pCR.
The researchers noted that these findings suggest that the positive impact of pCR on invasive disease-free survival is maintained among patients with and without BRCA mutations.
During the presentation, Richters said that “this highly effective regimen with only 12 weeks of [nab-paclitaxel] combined with [carboplatin] leads to a pCR rate of 64% in BRCA-associated gene disease. Hence, tumor BRCA mutation status could be a predictor for the use of anthracycline for de-escalation in case a pCR is observed.”
She noted that the findings are preliminary and will need to be validated with larger cohorts with longer follow-up periods.