Landry Kara K, Lyon Jessica L, Victoria Kitty E, Changizzadeh P Nick, Cole Bernard F, Pulluri Bhargavi, Sikov William M, Wood Marie E
Division of Hematology and Oncology, Department of Medicine, University of Vermont Medical Center, Burlington, VT, USA.
Larner College of Medicine at the University of Vermont, Burlington, VA, USA.
Breast Cancer (Dove Med Press). 2022 Mar 15;14:63-70. doi: 10.2147/BCTT.S342635. eCollection 2022.
Adding carboplatin to weekly paclitaxel as part of neoadjuvant chemotherapy (NACT) for stage II-III triple negative breast cancer (TNBC) has been shown to significantly increase the pathologic complete response (pCR) rate. Hematologic toxicities associated with every 3-week dosing of carboplatin have led some oncologists to explore weekly dosing as an alternative, but there are little published data comparing the two dosing schedules.
We performed a retrospective analysis of patients who received paclitaxel and carboplatin, usually followed by AC, as initial NACT for TNBC at two academic cancer centers between 2008 and 2018 for whom pathologic results and post-operative follow-up were available. We recorded pCR, defined as ypT0/isN0, treatment delivery and disease-free survival, censored as of the patient's last follow-up visit.
A total of 76 patients were identified (median age 49 years). A total of 47 received weekly carboplatin, of whom 83% received at least 11 of 12 planned doses, and 29 received every 3-week carboplatin, of whom 90% received all 4 planned doses. pCR rates were similar, 53% with weekly and 55% with every 3-week carboplatin dosing. At median follow-up of 18 months (range <1-118), 93% of patients who achieved pCR were alive and free from recurrence, compared to 74% of those who did not.
pCR rates were similar between patients receiving weekly or every 3-week carboplatin and were similar to those reported in prior trials with carboplatin. These data suggest that providers can choose either weekly or every 3-week carboplatin dosing without compromising the likelihood of achieving pCR.
对于II - III期三阴性乳腺癌（TNBC），在新辅助化疗（NACT）中加入卡铂作为每周紫杉醇方案的一部分，已显示可显著提高病理完全缓解（pCR）率。每3周一次卡铂给药相关的血液学毒性促使一些肿瘤学家探索每周给药作为替代方案，但比较这两种给药方案的已发表数据很少。
我们对2008年至2018年期间在两个学术癌症中心接受紫杉醇和卡铂（通常随后进行AC）作为TNBC初始NACT的患者进行了回顾性分析，这些患者有病理结果和术后随访资料。我们记录了定义为ypT0/isN0的pCR、治疗实施情况和无病生存期，随访截止至患者最后一次随访就诊。
共纳入76例患者（中位年龄49岁）。47例接受每周一次卡铂，其中83%接受了12个计划剂量中的至少11个；29例接受每3周一次卡铂，其中90%接受了所有4个计划剂量。pCR率相似，每周一次卡铂给药的为53%，每3周一次卡铂给药的为55%。在中位随访18个月（范围<1 - 118个月）时，达到pCR的患者中有93%存活且无复发，未达到pCR的患者中这一比例为74%。
接受每周或每3周一次卡铂给药的患者pCR率相似，且与先前卡铂试验报道的相似。这些数据表明，医疗人员可以选择每周或每3周一次卡铂给药，而不会影响达到pCR的可能性。
