Yıldırım Sedat, Başoğlu Tugba, Doğan Akif, Akdağ Goncagul, Kınıkoğlu Oguzcan, Topal Alper, Alan Ozkan, Solmaz Ali Alper, Gürbüz Mustafa, Çil Timucin, Çolak Rumeysa, Yılmaz Mesut, Kalem Ali, Sever Nadiye, Majıdova Nargiz, Karakoyun Kubilay, Sekmek Serhat, Saçlı Omer, Ozcelık Melike, Işık Deniz, Surmeli Heves, Sever Ozlem Nuray, Odabas Hatice, Yıldırım Mahmut Emre, Turan Nedim
Department of Medical Oncology, Kartal Dr. Lütfi Kirdar City Hospital, Health Science University, Istanbul, Cevizli, D-100 Güney Yanyol, Cevizli Mevkii No:47, 34865, Kartal/Istanbul, Turkey.
Department of Internal Medicine, Division of Medical Oncology, Gulhane Research & Training Hospital, Ankara, Turkey.
BMC Cancer. 2025 May 6;25(1):833. doi: 10.1186/s12885-025-14252-3.
Triple-negative breast cancer (TNBC) has a poor prognosis, and neoadjuvant chemotherapy (NACT) is the standard treatment for locally advanced TNBC. In this study, we aimed to evaluate the efficacy of adding carboplatin to NACT regarding pathological complete response (pCR) and survival in the HER2-low and HER2-zero subgroups of TNBC patients.
The study included 269 patients from five medical oncology clinics. Patients were divided into two groups: HER2-low (n = 152, 56.5%) and HER2-zero (n = 117, 43.5%). Among HER2-zero patients, 30 (25.6%) received carboplatin, while 38 (25.0%) HER2-low patients received carboplatin. The benefit of adding carboplatin to NACT regarding pCR and survival was assessed in both HER2-zero and HER2-low groups.
When patients were evaluated according to HER2 status, the pCR rates were significantly higher in the HER2-zero group compared to the HER2-low group (45.2% versus 23.7%, p < 0.001). In the HER2-zero group, patients who received carboplatin had significantly higher pCR rates (63.3% versus 39.0%, p = 0.021). Similarly, in the HER2-low group, adding carboplatin significantly increased the pCR rates (36.8% versus 19.3%, p = 0.028). While carboplatin improved pCR rates in both HER2 subgroups, this benefit was not observed in patients with Grade 1 tumors, HER2 score 2-FISH negative tumors, or based on BRCA mutation status. Patients with pCR exhibited significantly prolonged DFS and OS (p = 0.002, p < 0.001, respectively).
Our research demonstrates that the addition of carboplatin increases pCR rates in both HER2-zero and HER2-low patient cohorts. We suggest that carboplatin should be considered as an addition to standard neoadjuvant chemotherapy for eligible TNBC patients, regardless of HER2-zero or HER2-low status, when appropriate based on individual patient factors and toxicity considerations.
三阴性乳腺癌（TNBC）预后较差，新辅助化疗（NACT）是局部晚期TNBC的标准治疗方法。在本研究中，我们旨在评估在TNBC患者的HER2低表达和HER2零表达亚组中，NACT联合卡铂治疗在病理完全缓解（pCR）和生存方面的疗效。
该研究纳入了来自五家肿瘤内科诊所的269例患者。患者分为两组：HER2低表达组（n = 152，56.5%）和HER2零表达组（n = 117，43.5%）。在HER2零表达患者中，30例（25.6%）接受了卡铂治疗，而HER2低表达组中有38例（25.0%）接受了卡铂治疗。在HER2零表达组和HER2低表达组中均评估了NACT联合卡铂治疗在pCR和生存方面的获益情况。
根据HER2状态评估患者时，HER2零表达组的pCR率显著高于HER2低表达组（45.2%对23.7%，p < 0.001）。在HER2零表达组中，接受卡铂治疗的患者pCR率显著更高（63.3%对39.0%，p = 0.021）。同样，在HER2低表达组中，添加卡铂显著提高了pCR率（36.8%对19.3%，p = 0.028）。虽然卡铂提高了两个HER2亚组的pCR率，但在1级肿瘤患者、HER2评分2-FISH阴性肿瘤患者或基于BRCA突变状态的患者中未观察到这种获益。达到pCR的患者无病生存期（DFS）和总生存期（OS）显著延长（分别为p = 0.002，p < 0.001）。
我们研究表明，添加卡铂可提高HER2零表达和HER2低表达患者队列的pCR率。我们建议，在基于个体患者因素和毒性考虑适当的情况下，无论HER2零表达或HER2低表达状态如何，对于符合条件的TNBC患者，卡铂应被视为标准新辅助化疗的添加药物。
