Real-world outcomes of anthracycline-containing versus anthracycline-free carboplatin regimes in early-stage triple-negative breast cancer

Prof. Mary Schroeder

Triple-negative breast cancer (TNBC) is an aggressive disease with poor survival outcomes. With the integration of immunotherapy, the optimal neoadjuvant chemotherapy backbone is poorly defined. A retrospective cohort study investigated real-world outcomes among patients receiving a carboplatin-based regimen, with or without anthracyclines. The study included patients diagnosed with stage I-III TNBC who received neoadjuvant carboplatin plus taxane (CbT) or CbT with anthracyclines (AC-CbT). The primary outcome was pathologic complete response (pCR) rate. Among 878 patients, 41.2% received CbT and 58.8% received AC-CbT. Overall, 46% received pembrolizumab; 11.7% in the CbT group and 66.3% in the AC-CbT group. Among patients who underwent surgery pCR rates did not differ between the CbT and AC-CbT groups (47.2% versus 51.9%; OR 1.21; 95% CI 0.92-1.58) on univariate analysis; in multivariate adjusted analyses AC-CbT was not associated with higher odds of pCR (aOR 1.05; 95% CI 0.69-1.59). Other patient characteristics associated with pCR included pembrolizumab use, higher-grade disease, lower stage, and age at diagnosis. Use of carboplatin-containing regimens increased substantially over time. The authors conclude that in this real-world cohort, addition of anthracycline to carboplatin-containing regimens was not associated with improved pCR rates.