Neoadjuvant Chemotherapy of Triple-Negative Breast Cancer:
Evaluation of Early Clinical Response, Pathological Complete
Response Rates, and Addition of Platinum Salts Benefit Based on
Real-World Evidence

J 2021

Neoadjuvant Chemotherapy of Triple-Negative Breast Cancer: Evaluation of Early Clinical Response, Pathological Complete Response Rates, and Addition of Platinum Salts Benefit Based on Real-World Evidence

HOLÁNEK, Miloš, Iveta SELINGEROVÁ, Ondřej BÍLEK, Tomáš KAZDA, Pavel FABIAN et. al.

Basic information

Original name

Neoadjuvant Chemotherapy of Triple-Negative Breast Cancer: Evaluation of Early Clinical Response, Pathological Complete Response Rates, and Addition of Platinum Salts Benefit Based on Real-World Evidence

Authors

HOLÁNEK, Miloš (203 Czech Republic, belonging to the institution), Iveta SELINGEROVÁ (203 Czech Republic, guarantor, belonging to the institution), Ondřej BÍLEK (203 Czech Republic, belonging to the institution), Tomáš KAZDA (203 Czech Republic, belonging to the institution), Pavel FABIAN (203 Czech Republic), Lenka FORETOVÁ (203 Czech Republic), Mária ZVARÍKOVÁ (703 Slovakia, belonging to the institution), Radka OBERMANNOVÁ (203 Czech Republic, belonging to the institution), Ivana KOLOUŠKOVÁ (203 Czech Republic, belonging to the institution), Oldřich COUFAL (203 Czech Republic, belonging to the institution), Katarína PETRÁKOVÁ (203 Czech Republic, belonging to the institution), Marek SVOBODA (203 Czech Republic, belonging to the institution) and Alexandr POPRACH (203 Czech Republic, belonging to the institution)

Edition

Cancers, BASEL, MDPI, 2021, 2072-6694

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30204 Oncology

Country of publisher

Switzerland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 6.575

RIV identification code

RIV/00216224:14110/21:00121828

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.3390/cancers13071586

UT WoS

000638335700001

Keywords in English

triple-negative breast cancer; neoadjuvant chemotherapy; early clinical response; pathological complete response; brca mutation; platinum salts

Abstract

V originále

Simple Summary Neoadjuvant chemotherapy (NACT) is the standard treatment for early-stage triple-negative breast cancer (TNBC). Achieving pathological complete response (pCR) is considered an essential prognostic factor with favorable long-term outcomes. The administration of NACT regimens with platinum salts is associated with a higher pCR rate. However, with unclear treatment guidelines and at the expense of a higher incidence of adverse events. Identifying patients and circumstances in which the benefits of platinum NACT outweigh inconveniences is still an ongoing challenge. Considering early clinical response (ECR) after the initial standard NACT cycles together with other suitable predictors could be useful to decide about the administration of platinum salts in clinical practice. The results of this large single institutional retrospective study of consecutive patients showed the significant role of adding platinum salts in older patients with high-proliferative early responded tumors and persisted lymph nodes involvement regardless of BRCA1/2 status. Pathological complete response (pCR) achievement is undoubtedly the essential goal of neoadjuvant therapy for breast cancer, directly affecting survival endpoints. This retrospective study of 237 triple-negative breast cancer (TNBC) patients with a median follow-up of 36 months evaluated the role of adding platinum salts into standard neoadjuvant chemotherapy (NACT). After the initial four standard NACT cycles, early clinical response (ECR) was assessed and used to identify tumors and patients generally sensitive to NACT. BRCA1/2 mutation, smaller unifocal tumors, and Ki-67 >= 65% were independent predictors of ECR. The total pCR rate was 41%, the achievement of pCR was strongly associated with ECR (OR = 15.1, p < 0.001). According to multivariable analysis, the significant benefit of platinum NACT was observed in early responders >= 45 years, Ki-67 >= 65% and persisted lymph node involvement regardless of BRCA1/2 status. Early responders with pCR had a longer time to death (HR = 0.28, p < 0.001) and relapse (HR = 0.26, p < 0.001). The pCR was achieved in only 7% of non-responders. However, platinum salts favored non-responders' survival outcomes without statistical significance. Toxicity was significantly often observed in patients with platinum NACT (p = 0.003) but not for grade 3/4 (p = 0.155). These results based on real-world evidence point to the usability of ECR in NACT management, especially focusing on the benefit of platinum salts.

Links

90125, large research infrastructures

Name: BBMRI-CZ III

90128, large research infrastructures

Name: CZECRIN III

Citovat

HOLÁNEK, Miloš, Iveta SELINGEROVÁ, Ondřej BÍLEK, Tomáš KAZDA, Pavel FABIAN, Lenka FORETOVÁ, Mária ZVARÍKOVÁ, Radka OBERMANNOVÁ, Ivana KOLOUŠKOVÁ, Oldřich COUFAL, Katarína PETRÁKOVÁ, Marek SVOBODA and Alexandr POPRACH. Neoadjuvant Chemotherapy of Triple-Negative Breast Cancer: Evaluation of Early Clinical Response, Pathological Complete Response Rates, and Addition of Platinum Salts Benefit Based on Real-World Evidence. Cancers. BASEL: MDPI, 2021, vol. 13, No 7, p. 1-19. ISSN 2072-6694. Available from: https://dx.doi.org/10.3390/cancers13071586.

@article{1778199,
   author = {Holánek, Miloš and Selingerová, Iveta and Bílek, Ondřej and Kazda, Tomáš and Fabian, Pavel and Foretová, Lenka and Zvaríková, Mária and Obermannová, Radka and Koloušková, Ivana and Coufal, Oldřich and Petráková, Katarína and Svoboda, Marek and Poprach, Alexandr},
   article_location = {BASEL},
   article_number = {7},
   doi = {http://dx.doi.org/10.3390/cancers13071586},
   keywords = {triple-negative breast cancer; neoadjuvant chemotherapy; early clinical response; pathological complete response; brca mutation; platinum salts},
   language = {eng},
   issn = {2072-6694},
   journal = {Cancers},
   title = {Neoadjuvant Chemotherapy of Triple-Negative Breast Cancer: Evaluation of Early Clinical Response, Pathological Complete Response Rates, and Addition of Platinum Salts Benefit Based on Real-World Evidence},
   url = {https://www.mdpi.com/2072-6694/13/7/1586},
   volume = {13},
   year = {2021}
}

TY  - JOUR
ID  - 1778199
AU  - Holánek, Miloš - Selingerová, Iveta - Bílek, Ondřej - Kazda, Tomáš - Fabian, Pavel - Foretová, Lenka - Zvaríková, Mária - Obermannová, Radka - Koloušková, Ivana - Coufal, Oldřich - Petráková, Katarína - Svoboda, Marek - Poprach, Alexandr
PY  - 2021
TI  - Neoadjuvant Chemotherapy of Triple-Negative Breast Cancer: Evaluation of Early Clinical Response, Pathological Complete Response Rates, and Addition of Platinum Salts Benefit Based on Real-World Evidence
JF  - Cancers
VL  - 13
IS  - 7
SP  - 1-19
EP  - 1-19
PB  - MDPI
SN  - 20726694
KW  - triple-negative breast cancer
KW  - neoadjuvant chemotherapy
KW  - early clinical response
KW  - pathological complete response
KW  - brca mutation
KW  - platinum salts
UR  - https://www.mdpi.com/2072-6694/13/7/1586
N2  - Simple Summary Neoadjuvant chemotherapy (NACT) is the standard treatment for early-stage triple-negative breast cancer (TNBC). Achieving pathological complete response (pCR) is considered an essential prognostic factor with favorable long-term outcomes. The administration of NACT regimens with platinum salts is associated with a higher pCR rate. However, with unclear treatment guidelines and at the expense of a higher incidence of adverse events. Identifying patients and circumstances in which the benefits of platinum NACT outweigh inconveniences is still an ongoing challenge. Considering early clinical response (ECR) after the initial standard NACT cycles together with other suitable predictors could be useful to decide about the administration of platinum salts in clinical practice. The results of this large single institutional retrospective study of consecutive patients showed the significant role of adding platinum salts in older patients with high-proliferative early responded tumors and persisted lymph nodes involvement regardless of BRCA1/2 status. Pathological complete response (pCR) achievement is undoubtedly the essential goal of neoadjuvant therapy for breast cancer, directly affecting survival endpoints. This retrospective study of 237 triple-negative breast cancer (TNBC) patients with a median follow-up of 36 months evaluated the role of adding platinum salts into standard neoadjuvant chemotherapy (NACT). After the initial four standard NACT cycles, early clinical response (ECR) was assessed and used to identify tumors and patients generally sensitive to NACT. BRCA1/2 mutation, smaller unifocal tumors, and Ki-67 >= 65% were independent predictors of ECR. The total pCR rate was 41%, the achievement of pCR was strongly associated with ECR (OR = 15.1, p < 0.001). According to multivariable analysis, the significant benefit of platinum NACT was observed in early responders >= 45 years, Ki-67 >= 65% and persisted lymph node involvement regardless of BRCA1/2 status. Early responders with pCR had a longer time to death (HR = 0.28, p < 0.001) and relapse (HR = 0.26, p < 0.001). The pCR was achieved in only 7% of non-responders. However, platinum salts favored non-responders' survival outcomes without statistical significance. Toxicity was significantly often observed in patients with platinum NACT (p = 0.003) but not for grade 3/4 (p = 0.155). These results based on real-world evidence point to the usability of ECR in NACT management, especially focusing on the benefit of platinum salts.
ER  -

HOLÁNEK, Miloš, Iveta SELINGEROVÁ, Ondřej BÍLEK, Tomáš KAZDA, Pavel FABIAN, Lenka FORETOVÁ, Mária ZVARÍKOVÁ, Radka OBERMANNOVÁ, Ivana KOLOUŠKOVÁ, Oldřich COUFAL, Katarína PETRÁKOVÁ, Marek SVOBODA and Alexandr POPRACH. Neoadjuvant Chemotherapy of Triple-Negative Breast Cancer: Evaluation of Early Clinical Response, Pathological Complete Response Rates, and Addition of Platinum Salts Benefit Based on Real-World Evidence. \textit{Cancers}. BASEL: MDPI, 2021, vol.~13, No~7, p.~1-19. ISSN~2072-6694. Available from: https://dx.doi.org/10.3390/cancers13071586.

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