Dose dense versus 3 weekly AC during neoadjuvant chemoimmunotherapy for triple negative breast cancer.
Renata Colombo BonadioIsadora Martins de SousaFlávia Cavalcanti BalintAna Carolina Marin CominiMonique Celeste TavaresFernanda MadasiJose BinesRafael Dal Ponte FerreiraDaniela Dornelles RosaCandice Lima SantosZenaide Silva de SouzaDaniele Assad-SuzukiJúlio Antônio Pereira de AraújoDébora de Melo GagliatoCarlos Henrique Dos AnjosBruna M ZucchettiAnezka FerrariMayana Lopes de BritoRenata CangussuMaria Marcela Fernandes MonteiroPaulo M HoffLaura TestaRomualdo Barroso-SousaPublished in: NPJ breast cancer (2024)
Neoadjuvant pembrolizumab plus chemotherapy (P + CT) has emerged as a standard of care for stage II-III triple-negative breast cancer (TNBC). However, the best anthracycline-cyclophosphamide (AC) schedule remains to be determined. While the KEYNOTE-522 regimen employs AC every 3 weeks (q3w AC), previous studies have shown overall survival benefits of dose-dense regimens for early-stage breast cancer. The Neo-Real study (GBECAM-0123) is a real-world data effort evaluating patients with TNBC treated with neoadjuvant P + CT in ten cancer centers since July 2020. The objective of this analysis was to evaluate the effectiveness and safety of dose-dense AC (ddAC) versus q3w AC. Among 333 patients included until November 2023, 311 completed neoadjuvant therapy and 279 underwent surgery with pathology reports available; ddAC was used in 58.2% and q3w AC in 41.8% of the cases. Most patients (69.1%) had stage II TNBC. A pCR was observed in 65.4% with ddAC and 58.7% with q3w AC (P = 0.260), while RCB 0-1 occurred in 82.4% and 73.5%, respectively (P = 0.115). Patients with stage III disease had a numerically higher pCR with ddAC (59% vs 40%, P = 0.155), while pCR rates were similar regardless of AC regimen in stage II disease (66.6% vs 64.5%; P = 0.760). While no significant disparities in drug discontinuation was noted, ddAC showed a trend towards higher rates of grade ≥3 AE (40.5% vs. 30.7%, P = 0.092). The Neo-Real study could not rule out a difference between ddAC and q3w AC during neoadjuvant P + CT. The observation of a potentially higher pCR with ddAC in stage III disease warrants further investigation.
Keyphrases
- rectal cancer
- locally advanced
- lymph node
- early stage
- computed tomography
- healthcare
- contrast enhanced
- squamous cell carcinoma
- image quality
- stem cells
- clinical trial
- low dose
- minimally invasive
- machine learning
- emergency department
- high dose
- neoadjuvant chemotherapy
- newly diagnosed
- chronic kidney disease
- bone marrow
- palliative care
- young adults
- pain management
- percutaneous coronary intervention
- chronic pain
- patient reported outcomes
- coronary artery bypass
- electronic health record
- peritoneal dialysis
- free survival
- acute coronary syndrome
- drug induced