Pathological response and survival in triple-negative breast cancer following neoadjuvant carboplatin plus docetaxel

Purpose: Prognostic value of pCR and extent of pathological response attained with anthracycline-free platinum plus taxane neoadjuvant chemotherapy (NAC) in TNBC is unknown. We report recurrence-free survival (RFS) and overall survival (OS) according to degree of pathological response in patients treated with carboplatin (Cb) plus docetaxel (D) NAC. Experimental Design: 190 patients with stage I-III TNBC were treated with neoadjuvant Cb(AUC6) plus D(75mg/m²) every 21 days x 6 cycles. pCR (no evidence of invasive tumor in breast and axilla) and Residual Cancer Burden (RCB) were evaluated. Patients were followed for recurrence and survival. Extent of pathological response was associated with RFS and OS using the Kaplan-Meier method. Results: Median age was 51 years, and 52% were node-positive. pCR and RCB I rates were 55% and 13%, respectively. 5% of pCR patients, 0% of RCB I patients, and 58% of RCB II/III patients received adjuvant anthracyclines. Three-year RFS and OS were 79% and 87%, respectively. Three-year RFS was 90% in patients with pCR and 66% in those without pCR (HR=0.30; 95% CI: 0.14-0.62, P=0.0001). 3-year OS was 94% in patients with pCR and 79% in those without pCR (HR=0.25; 95% CI: 0.10-0.63, P=0.001). Patients with RCB I demonstrated 3-year RFS (93%) and OS (100%) similar to those with pCR. On multivariable analysis, higher tumor stage, node positivity, and RCB II/III were associated with worse RFS. Conclusions: Neoadjuvant CbD yields encouraging efficacy in TNBC. Patients achieving pCR or RCB I with this regimen demonstrate excellent 3-year RFS and OS without adjuvant anthracycline.

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