Inclusion of Platinum Agents in Neoadjuvant Chemotherapy Regimens for Triple-Negative Breast Cancer Patients: Development of GRADE (Grades of Recommendation, Assessment, Development and Evaluation) Recommendation by the Italian Association of Medical Oncology (AIOM).
Maria Vittoria DieciLucia Del MastroMichela CinquiniFilippo MontemurroLaura BiganzoliLaura CortesiAlberto ZambelliCarmen CriscitielloAlessia LevaggiBenedetta ConteMassimo CalabreseAlba FiorentinoCaterina MarchioCorrado TinterriVeronica Andrea FittipaldoGiovanni PappagalloStefania GoriPublished in: Cancers (2019)
In the absence of identified therapeutic targets, chemotherapy is the main systemic treatment option for triple-negative breast cancer (TNBC). The achievement of a pathological complete response (pCR) after neoadjuvant chemotherapy leads to good outcome, whereas patients not achieving a pCR are at high risk of relapse. Various trials have evaluated the inclusion of platinum in neoadjuvant chemotherapy regimens for TNBC, leading to non-univocal results. The panel of the Italian Association of Medical Oncology (AIOM) Guidelines on Breast Cancer developed a clinical recommendation on the addition of platinum to anthracycline/taxane-based neoadjuvant chemotherapy for TNBC by using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology and the Evidence to Decision framework (EtD). Five studies were eligible. The panel identified the following outcomes of benefit: pCR (critical), disease/event-free survival (DFS/EFS, critical), and overall survival (OS, critical). The panel identified febrile neutropenia (critical), serious adverse events (critical), anemia grade 3-4 (important), thrombocytopenia grade 3-4 (important) as outcomes of harms. The probability of pCR was higher in the platinum-based chemotherapy group versus control group (RR = 1.45, 95%CI 1.28-1.64); however, no impact on long-term outcome was observed. Neoadjuvant treatment regimens containing platinum resulted in a non-significant increase in the risk of febrile neutropenia and in a significant increase in the risk serious adverse events, G3-G4 anemia and G3-G4 thrombocytopenia: 11.3% versus 0.8%, RR = 15.66 (95%CI 6.38-38.44). The panel judged uncertain/favorable the benefit/harms balance. The panel's final recommendation was conditional in favor of the inclusion of platinum in anthracycline/taxane-based neoadjuvant regimens for TNBC.
Keyphrases
- neoadjuvant chemotherapy
- locally advanced
- rectal cancer
- lymph node
- squamous cell carcinoma
- sentinel lymph node
- end stage renal disease
- free survival
- chronic kidney disease
- radiation therapy
- ejection fraction
- newly diagnosed
- chemotherapy induced
- prognostic factors
- skeletal muscle
- young adults
- urinary tract infection
- metabolic syndrome
- case control
- glycemic control
- drug induced
- childhood cancer