title: Anthracycline-Free Neoadjuvant Chemotherapy Ensures Higher Rates of Pathologic Complete Response in Breast Cancer.
abstract: Neoadjuvant chemotherapy (NCT) is a standard of care for locally advanced and initially inoperable breast cancer. NCT can test chemotherapy efficacy and can be followed by breast-conserving surgery. Considering taxanes as one of the most effective agents, we analyzed the efficacy of a neoadjuvant schedule without anthracyclines and based only on taxanes and carboplatin, trying to avoid cardiotoxicity, which is the most serious side effect correlated with anthracyclines.
  
  
  
  We enrolled 61 patients with breast cancer, belonging to 4 subgroups, according to molecular phenotypes: 24 triple-negative/basal-like, 13 HER2-like, 20 luminal B, and 4 luminal A. All patients underwent weekly chemotherapy with carboplatin AUC2, paclitaxel 80 mg/m2, with trastuzumab (in case of HER2 positivity) 2 mg/kg, except for luminal A patients, who underwent only hormonal therapy. Among 61 patients, 26 (43%) received modified radical mastectomy and 35 (57%) received breast-conserving surgery.
  
  
  
  The patients obtaining pathologic complete response (pCR) were 20 (83%) of 24 triple-negative/basal-like, 10 (76%) of 13 HER2-like, 6 (30%) of 20 luminal B, and 3 (75%) of 4 luminal A. All the patients were evaluated for toxicity: no grade 4 was detected, 5 patients experienced grade 3 neuropathy, then reverted to G2 after chemotherapy discontinuation. At a minimum follow-up of 5 years, median overall survival was 48 months.
  
  
  
  Taxane/carboplatin-based/anthracycline-free NCT is the best treatment for inoperable breast cancer in terms of efficacy and toxicity, because this approach avoids cardiotoxicity and obtains an optimal rate (64%) of pCR, with an important impact on survival.
authors.affiliation: Department of Experimental Medicine, Sapienza University, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: De Iuliis
authors.affiliation: Department of Experimental Medicine, Sapienza University, Rome, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Salerno
authors.affiliation: Policlinico Umberto I, Rome, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Corvino
authors.affiliation: Policlinico Umberto I, Rome, Italy.
authors.forename: Debora
authors.initials: D
authors.lastname: D'Aniello
authors.affiliation: Policlinico Umberto I, Rome, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Cefalì
authors.affiliation: Department of Experimental Medicine, Sapienza University, Rome, Italy.
authors.forename: Ludovica
authors.initials: L
authors.lastname: Taglieri
authors.affiliation: Policlinico Umberto I, Rome, Italy.
authors.forename: Rosina
authors.initials: R
authors.lastname: Lanza
authors.affiliation: Department of Experimental Medicine, Sapienza University, Rome, Italy. Electronic address: susanna.scarpa@uniroma1.it.
authors.forename: Susanna
authors.initials: S
authors.lastname: Scarpa
mesh_terms: D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016190:Carboplatin / Q000008:administration & dosage; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D000068878:Trastuzumab / Q000008:administration & dosage
chemical_list: D018943:Anthracyclines; D016190:Carboplatin; D000068878:Trastuzumab; D017239:Paclitaxel
keywords: Carboplatin; Pathologic complete response; Survival; Taxane; Toxicity