Experts consensus on platinum-based neoadjuvant therapy for triple negative breast cancer (2023 version)

doi:10.3877/cma.j.issn.1674-0807.2024.01.001

Abstract

Abstract:

Neoadjuvant therapy is the standard approach for early-stage high-risk triple negative breast cancer (TNBC) and the addition of platinum-based drugs to neoadjuvant regimens significantly improves pathological complete response rates and long-term survival of patients. However, there are still discrepancies in the recommendations for the application of platinum-based drugs in neoadjuvant therapy for TNBC between domestic and international guidelines. Therefore, a consensus panel of experts from the departments of breast surgery, internal medicine and oncology has compiled this consensus, integrating domestic and international guidelines and important literature. This consensus provides evidence-based analysis, key opinion extraction, and expert opinion voting on topics including neoadjuvant therapy regimens for TNBC, the mechanism of platinum-based drug action, the application value of platinum-based drugs in neoadjuvant therapy and adjuvant therapy for TNBC, predictive factors for platinum efficacy, and treatment-related adverse reactions, aiming to provide recommendations and guidances for the clinical application of platinum-based drugs in neoadjuvant therapy for TNBC.

Key words: Triple negative breast neoplasms, Platinum, Neoadjuvant therapy, Consensus

Breast Disease Branch of Guangdong Medical Association (Youth Committee of Breast Disease Branch of Guangdong Medical Association);, Breast Cancer Study Group Along the Yangtze River (YBCSG);, Breast Disease Branch of Chongqing Medical Association;, Breast Cancer Prevention and Treatment Committee of Guangdong Preventive Medicine Association. Experts consensus on platinum-based neoadjuvant therapy for triple negative breast cancer (2023 version)[J]. Chinese Journal of Breast Disease(Electronic Edition), 2024, 18(01): 1-10.

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研究名称	研究分期	组别方案	样本量	pCR (%)	P值	生存率(%)	P值
GEICAM/2006-03^[17]	2	EC→DCb	48	30	0.606	－	－
		EC→D	46	35
GeparSixto GBG66^[18,31]	2	P＋Dox＋Bev＋Cb	158	53.2	0.005	86.1^a	0.024 4
		P＋Dox＋Bev	157	36.9		75.8^a
CALGB 40603(Alliance)^[19,32]	2	P＋Cb±Bev→ddAC	221	54	0.002 9	70.4^b	0.721 0
		P±Bev→ddAC	212	41		70.1^b
ChiCTR-TRC-14005019^[20,33]	2	DEL	62	38.7	0.001	89.9^c	0.028
		DE	63	12.7		80.2^c
BrighTNess^[21,30]	3	PCb→AC	160	58	<0.001	79.3^d	0.02
		P→AC	158	31		68.5^d
NCT03168880^[23]	3	PCb→AC/EC	361	55.2	0.000 4	70.6^e	0.073
		P→AC/EC	356	41.5		64.5^e
NCT0205986^[24]	2	PCb	14	57.14	－	－	－
NCT02302742^[25]	－	DCb	190	55	－	－	－
NCT01276769^[26]	2	PCb	47	38.6	0.014	77.6^f	0.043
		PE	44	14.0		56.2^f
NeoSTOP^[27]	2	CbD	52	54	0.974	－	－
		CbP→AC	48	54
NeoCART^[28]	2	DCb	44	61.4	0.004	90.8^g	0.683
		EC-D	44	38.6		88.3^g
WSG-ADAPT-TN^[29]	2	Nab-P＋Cb	146	45.9	0.002	72.6^h	0.856
		Nab-P＋Gem	178	28.7		73.7^h

研究名称	研究分期	组别方案	样本量	pCR (%)	P值	生存率(%)	P值
GEICAM/2006-03^[17]	2	EC→DCb	48	30	0.606	－	－
		EC→D	46	35
GeparSixto GBG66^[18,31]	2	P＋Dox＋Bev＋Cb	158	53.2	0.005	86.1^a	0.024 4
		P＋Dox＋Bev	157	36.9		75.8^a
CALGB 40603(Alliance)^[19,32]	2	P＋Cb±Bev→ddAC	221	54	0.002 9	70.4^b	0.721 0
		P±Bev→ddAC	212	41		70.1^b
ChiCTR-TRC-14005019^[20,33]	2	DEL	62	38.7	0.001	89.9^c	0.028
		DE	63	12.7		80.2^c
BrighTNess^[21,30]	3	PCb→AC	160	58	<0.001	79.3^d	0.02
		P→AC	158	31		68.5^d
NCT03168880^[23]	3	PCb→AC/EC	361	55.2	0.000 4	70.6^e	0.073
		P→AC/EC	356	41.5		64.5^e
NCT0205986^[24]	2	PCb	14	57.14	－	－	－
NCT02302742^[25]	－	DCb	190	55	－	－	－
NCT01276769^[26]	2	PCb	47	38.6	0.014	77.6^f	0.043
		PE	44	14.0		56.2^f
NeoSTOP^[27]	2	CbD	52	54	0.974	－	－
		CbP→AC	48	54
NeoCART^[28]	2	DCb	44	61.4	0.004	90.8^g	0.683
		EC-D	44	38.6		88.3^g
WSG-ADAPT-TN^[29]	2	Nab-P＋Cb	146	45.9	0.002	72.6^h	0.856
		Nab-P＋Gem	178	28.7		73.7^h

研究名称	研究分期	组别方案	样本量	是否含铂	pCR (%)	P值	生存率(%)	P值
KN-522^[36,37]	3	(PCb→AC)＋Pembrolizumab→Pembrolizumab	1 174	是	64.8	<0.001	91.3^a	<0.05
		PCb→AC			51.2		85.3^a
NeoTRIP^[38]	3	PCb＋Atezolizumab	280	是	48.6	0.480	－	－
		PCb			44.4
NeoPACT^[39]	2	TCb＋Pembrolizumab	150	是	58	－	89.0^b	－
GeparNuevo^[58]	2	(PCb→AC)＋Durvalumab	174	是	53.4	0.287	85.6^c	0.036
		PCb→AC			44.2		77.2^c
IMpassion031^[59]	3	(P→AC)＋Atezolizumab	333	否	58	0.004 4	－	－
		P→AC			41

研究名称	研究分期	组别方案	样本量	是否含铂	pCR (%)	P值	生存率(%)	P值
KN-522^[36,37]	3	(PCb→AC)＋Pembrolizumab→Pembrolizumab	1 174	是	64.8	<0.001	91.3^a	<0.05
		PCb→AC			51.2		85.3^a
NeoTRIP^[38]	3	PCb＋Atezolizumab	280	是	48.6	0.480	－	－
		PCb			44.4
NeoPACT^[39]	2	TCb＋Pembrolizumab	150	是	58	－	89.0^b	－
GeparNuevo^[58]	2	(PCb→AC)＋Durvalumab	174	是	53.4	0.287	85.6^c	0.036
		PCb→AC			44.2		77.2^c
IMpassion031^[59]	3	(P→AC)＋Atezolizumab	333	否	58	0.004 4	－	－
		P→AC			41

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