NEOADJUVANT WEEKLY NAB-PACLITAXEL PLUS CARBOPLATIN FOLLOWED BY DOXORUBICIN PLUS CYCLOPHOSPHAMIDE WITH BEVACIZUMAB ADDED CONCURRENTLY TO CHEMOTHERAPY FOR OPERABLE TRIPLE-NEGATIVE INVASIVE BREAST CANCER

  • Jasgit C. Sachdev Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Scottsdale, AZ
  • Jessica N. Snider University of Tennessee, Memphis, Tennessee,
  • Jeffrey W. Allen Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Scottsdale, Arizona,
  • Lee S. Schwartzberg The West Clinic, Memphis, Tennessee,
  • Robyn R. Young The Center for Cancer and Blood Disorders, Fort Worth, Texas,
  • Ahmed Y. Javed Baptist Cancer Center, Memphis, Tennessee,
  • Matthew P. Smeltzer University of Memphis, Memphis, Tennessee
  • Furhan Yunus Baptist Cancer Center, Memphis, Tennessee,
  • Carmel S. Verrier 5Baptist Cancer Center, Memphis, Tennessee,
  • Mohammad Jahanzeb Sylvester Comprehensive Cancer Center, University of Miami, Deerfield Beach, FL,

Abstract

Purpose: This phase II neoadjuvant study investigated whether nab paclitaxel, carboplatin and bevacizumab given before neoadjuvant doxorubicin/cyclophosphamide (AC) produced higher pathologic complete response (pCR) rates in triple- negative breast cancer (TNBC) compared with historical results achieved with standard anthracycline/taxane regimens.

Patients and Methods: Eligible patients with operable TNBC ≥2 cm received four cycles of carboplatin (area under the curve 6, day 1) plus nab-paclitaxel (100 mg/m2, days 1, 8 and 15) every 28 days, followed by four 14-day cycles of AC neoadjuvantly, with bevacizumab 10 mg/kg every 14 days for the rst 6 cycles of neoadjuvant chemotherapy, resuming postoperatively to complete 1 year of antibody treatment. In breast pCR and pCR (breast + nodes) were primary and secondary endpoints, respectively.

Results: Due to slow accrual, the study was closed after enrollment of 42 of 60 planned patients. Of the 38 patients who underwent surgery (ef cacy population), 22 (58%) achieved an in-breast pCR and 19 (50%) achieved a pCR (breast + nodes). Neutropenia was the most common Grade 3/4 adverse event (57% Grade 3 and 31% Grade 4), but only 1 patient required hospitalisation and IV antibiotics for neutropenic fever. Other Grade 3/4 events included anaemia (24%), thrombocytopenia (29%) and peripheral neuropathy (Grade 3, 5%).

Conclusion: Our results demonstrate a substantially higher pCR rate, both in-breast and breast + nodes, with the combination of nab paclitaxel plus carboplatin followed by AC, with concurrent bevacizumab, versus historic pCR rates with anthracycline-taxane regimens alone, supporting further investigation of this regimen, preferably in molecularly driven subsets, for the neoadjuvant treatment of patients with TNBC.

Key words: Bevacizumab, breast cancer, carboplatin, nab-paclitaxel, neoadjuvant, triple-negative 

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How to Cite
1.
Sachdev JC, Snider JN, Allen JW, Schwartzberg LS, Young RR, Javed AY, Smeltzer MP, Yunus F, Verrier CS, Jahanzeb M. NEOADJUVANT WEEKLY NAB-PACLITAXEL PLUS CARBOPLATIN FOLLOWED BY DOXORUBICIN PLUS CYCLOPHOSPHAMIDE WITH BEVACIZUMAB ADDED CONCURRENTLY TO CHEMOTHERAPY FOR OPERABLE TRIPLE-NEGATIVE INVASIVE BREAST CANCER. J Cancer Allied Spec [Internet]. 1 [cited 2020Aug.15];2(1). Available from: https://journals.sfu.ca/jcas/index.php/jcas/article/view/59
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Original Research Article