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Role of Neoadjuvant Chemotherapy Evolving in TNBC

Danielle Bucco
Published: Monday, Dec 04, 2017

Melanie Majure, MD
Melanie Majure, MD
The use of neoadjuvant chemotherapy to treat patients with triple-negative breast cancer (TNBC) is becoming more common and being explored in clinical trials, according to Melanie Majure, MD.

on Breast Cancer, Majure, a clinical instructor, Department of Medicine, Division of Hematology/Oncology, the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco, discussed the optimal role chemotherapy for patients with TNBC and the importance of achieving a pCR.

OncLive: Please provide an overview of your presentation on optimal chemotherapy use for patients with TNBC.

Majure: I had the opportunity to speak about optimal chemotherapy regimens for TNBC. I focused my talk primarily on treatment in the early-stage setting, where I believe the data are most important. If you think about chemotherapy regimens in the metastatic setting, there has not been significant data to recommend 1 chemotherapy regimen over another.

I also discussed adding carboplatin in the neoadjuvant setting. There were 4 trials, the most important being CALGB 40603. That study essentially demonstrated improved rates of pCR with the addition of carboplatin, but had different results from other studies in terms of DFS. The phase II study was powered to demonstrate the impact on pCR, not on DFS.

How has the role of chemotherapy evolved over the past few years?

In the academic setting, we are not doing things differently. However, it is my impression that the use of neoadjuvant chemotherapy to treat TNBC is becoming more common. I see patients with metastatic recurrence who received surgery first and then go on to adjuvant chemotherapy, but we don’t know how those patients will do or what else to give them. It’s not so much a question of how the role of chemotherapy changes, but about the practice patterns of the rates of adjuvant treatment versus neoadjuvant use in TNBC.

In the last year, we have become more comfortable recommending patients to proceed with adjuvant capecitabine in the context of having residual disease after neoadjuvant chemotherapy. This is based off the CREATE-X trial, which has been published in the New England Journal of Medicine. This trial discusses significant additional benefits in both DFS and OS for patients with TNBC.


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