Impact of the addition of carboplatin to anthracycline-taxane-based neoadjuvant chemotherapy on survival inBRCA1/2-mutated triple-negative breast cancer

Whether adding carboplatin to standard neoadjuvant chemotherapy improves survival inBRCA1/2-mutated triple-negative breast cancer (TNBC) is unknown. In this retrospective study, we aimed to explore the efficacy of anthracycline-taxane (A-T)-based or anthracycline-taxane/carboplatin (A-TP)-based neoadjuvant chemotherapy inBRCA1/2-mutated TNBC. A total of 1585 operable primary breast cancer patients were treated with either neoadjuvant A-T (n = 886) or A-TP regimen (n = 699).BRCA1andBRCA2germline mutations were determined in all subjects. Pathological complete response (pCR), recurrence-free survival (RFS), distant recurrence-free survival (DRFS) and overall survival (OS) were estimated. Of the entire cohort, 102 patients (6.4%) carried a pathogenicBRCA1/2germline mutation. After a median follow-up of 81 months, no significant differences in survival between the A-T and A-TP arms were found in the entire cohort. However, among 288 TNBC patients,BRCA1/2mutation carriers had significantly better survival when treated with the A-TP regimen than with the A-T regimen (5-year RFS: 82.6% vs 47.9%;P= .024; 5-year DRFS: 88.5% vs 46.9%;P= .010; 5-year OS: 88.2% vs 49.9%;P= .036). Multivariate analyses revealed that the A-TP regimen was a significantly favourable factor for RFS and DRFS and showed a trend towards better OS when compared with the A-T regimen inBRCA1/2-mutated TNBC (RFS: adjusted hazard ratio [HR], 0.24; 95% confidence interval [CI], 0.06-0.91,P= .035; DRFS: HR, 0.17; 95% CI, 0.03-0.80;P= .025; OS: HR, 0.29; 95% CI, 0.06-1.49;P= .14). Our study suggested thatBRCA1/2-mutated TNBC patients gain a survival benefit when carboplatin is added to standard A-T-based neoadjuvant chemotherapy.