“… 95 – 98 The subgroup analysis of five clinical trials, conducted in TNBC patients treated with neoadjuvant platinum-containing therapies combined with taxanes, showed a pCR rate ranging from 33% to 67%. 95 – 99 These data are in accordance with the results from the GeparSixto study, where the addition of carboplatin to anthracycline or taxane-based therapy improved the pCR from 36.9% to 53.2%. 100 A large meta-analysis (included six randomized controlled trials and 22 retrospective or prospective studies) strongly confirmed the advantage due to platinum addition in both the objective response rate (86.7%) and the pCR rate (48.4%).…”
Triple-negative breast cancer (TNBC) remains the poorest-prognosis breast cancer (BC) subtype. Gene expression profiling has identified at least six different triple-negative subtypes with different biology and sensitivity to therapies. The heterogeneous nature of TN tumors may justify the difficulty in treating this BC subtype. Several targeted agents have been investigated in clinical trials without demonstrating a clear survival benefit. Therefore, systemic chemotherapy remains the cornerstone of current clinical practice. Improving the knowledge of tumor biology is mandatory for patient management. In stages II and III, neoadjuvant systemic treatment is an effective option of care. The achievement of a pathological complete response represents an optimal surrogate for survival outcome as well as a test for tumor drug sensitivity. In this review, we provide a brief description of the main predictive biomarkers for tumor response to systemic treatment. Moreover, we review the treatment strategies investigated for TNBCs in neoadjuvant settings focusing on experimental drugs such as immunotherapy and poly [ADP-ribose] polymerase inhibitors that hold promise in the treatment of this aggressive disease. Therefore, the management of TNBC represents an urgent, current, unmet need in daily clinical practice. A key recommendation is to design biology-driven clinical trials wherein TNBC patients may be treated on the basis of tumor molecular profile.
“… 95 – 98 The subgroup analysis of five clinical trials, conducted in TNBC patients treated with neoadjuvant platinum-containing therapies combined with taxanes, showed a pCR rate ranging from 33% to 67%. 95 – 99 These data are in accordance with the results from the GeparSixto study, where the addition of carboplatin to anthracycline or taxane-based therapy improved the pCR from 36.9% to 53.2%. 100 A large meta-analysis (included six randomized controlled trials and 22 retrospective or prospective studies) strongly confirmed the advantage due to platinum addition in both the objective response rate (86.7%) and the pCR rate (48.4%).…”
Triple-negative breast cancer (TNBC) remains the poorest-prognosis breast cancer (BC) subtype. Gene expression profiling has identified at least six different triple-negative subtypes with different biology and sensitivity to therapies. The heterogeneous nature of TN tumors may justify the difficulty in treating this BC subtype. Several targeted agents have been investigated in clinical trials without demonstrating a clear survival benefit. Therefore, systemic chemotherapy remains the cornerstone of current clinical practice. Improving the knowledge of tumor biology is mandatory for patient management. In stages II and III, neoadjuvant systemic treatment is an effective option of care. The achievement of a pathological complete response represents an optimal surrogate for survival outcome as well as a test for tumor drug sensitivity. In this review, we provide a brief description of the main predictive biomarkers for tumor response to systemic treatment. Moreover, we review the treatment strategies investigated for TNBCs in neoadjuvant settings focusing on experimental drugs such as immunotherapy and poly [ADP-ribose] polymerase inhibitors that hold promise in the treatment of this aggressive disease. Therefore, the management of TNBC represents an urgent, current, unmet need in daily clinical practice. A key recommendation is to design biology-driven clinical trials wherein TNBC patients may be treated on the basis of tumor molecular profile.
“…Longer‐term follow‐up and confirmatory data from subgroups at highest and lowest risk may help determine which patients stand to benefit from adjuvant anthracycline therapy. Future studies' randomized trials may evaluate other alternatives to an anthracycline regimen such as a platinum‐based nonanthracycline therapy for triple‐negative breast cancer, which has shown promising pCR rates as neoadjuvant therapy . Despite the discordant study results, it is clear that the magnitude of benefit of adjuvant anthracyclines compared with a taxane regimen is small and may be primarily concentrated in patients with triple negative tumors or extensive lymph node involvement.…”
In patients with early breast cancer, the choice of adjuvant chemotherapy should be based on its effectiveness in reducing breast cancer recurrences and its short- and long-term toxicities. Although adjuvant anthracycline and taxane chemotherapy has the most data supporting its effectiveness, anthracyclines carry a small but important increased risk for cardiotoxicity and leukemia. Two recent clinical trials help describe the degree of benefit with adjuvant anthracycline therapy compared with taxane therapy alone. They suggest that in patients with hormone receptor-positive breast cancer and limited lymph node involvement, nonanthracycline taxane-based adjuvant therapy may be adequate.
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