Intensive neoadjuvant chemotherapy for breast cancer – pro
Recent yeas have brought several trials that attempted to intensify neoadjuvant chemotherapy for breast cancer by adding various agents to the standard neoadjuvant drugs, cyclophosphahamide, taxanes and doxorubicin. Such agents included carboplatin, bevacizumab and, in teh ISPY2 trial, valapirinib. The phase II CALGB/Alliance 40603 study enrolled 454 patients with stage II/III triple-negative breast cancer, randomly assigning them to standard neoadjuvant chemotherapy or chemotherapy plus carboplatin, bevacizumab, or the combination. Patients received weekly paclitaxel for 12 courses plus dose-dense anthracycline/cyclophosphamide alone, or with the addition of bevacizumab every 2 weeks for nine cycles or the addition of carboplatin AUC 6 every 3 weeks for four cycles. For patients receiving carboplatin, 60% achieved a pathologic complete response in the breast, compared to 46% of those not receiving carboplatin. When defined as no disease in the breast or axillae, pathologic complete response rates were 54% with carboplatin, vs 41% without carboplatin, a 71% increase (P = .0029. Bevacizimab appeared to increse toxicity and be only minimally more effective for response.This far we cans ay that veliparib and carboplatin with a 90% chance of successdeserve to be farther tested. AbbVie is planning to open such a trial in 2014.
Sikov WM, et al: Impact of the addition of carboplatin and/or bevacizumab to neoadjuvant weekly paclitaxel followed by dose-dense AC on pathologic complete response rates in triple-negative breast cancer. 2013 San Antonio Breast Cancer Symposium. Abstract S5-01. Presented December 13, 2013.
2. von Minckwitz G, et al: A randomized phase II trial investigating the addition of carboplatin to neoadjuvant therapy for triple-negative and HER2-positive early breast cancer (GeparSixto). 2013 ASCO Annual Meeting. Abstract 1004. Presented June 3, 2012.