Triple negative breast cancer (TNBC) accounts for 15-20% of Breast cancers1. Triple negative tumor status is known to be an adverse characteristic of breast cancer, thereby it is more aggressive than the other subtypes2. They are also predisposed to harbor BRCA 1/2 gene mutations which plays a crucial role in genome integrity through the DNA damage response and repair pathway via the homologous recombination repair. Mutations that disrupt BRCA gene function may lead to progressive cancer and platinum sensitivity3. Platinum-based treatment for TNBC in the early and advanced stage is still controversial and is currently not part of any guidelines. Recent studies have shown promising activity of this regimen. In this meta-analysis, pathologic complete response (pCR) after neoadjuvant treatment and progression-free survival (PFS) in the advanced setting were analyzed.
Pubmed, Embase, Cochrane, Clinical trials databases and hand search were utilized to identify randomized controlled trials (RCTs) investigating the use of Platinum-based systemic chemotherapy in TNBC until 2018. Using the random effects model, pooled Odds ratios (ORs) with 95% confidence intervals (CI) were calculated for pCR, and Hazard Ratios (HRs) with 95% CI for PFS.
Eleven randomized controlled trials were included in this study (N = 2946). Eight studies (N = 2415) were included for analysis of pCR and 3 studies were analyzed for PFS. Platinum-based systemic chemotherapy showed increased pCR with from 27% to 40% (OR 1.75, 95% CI 1.46-2.62, P < 0.0001) in the neoadjuvant treatment of TNBC. In the analysis of three RCTs with advanced TNBC (N = 531), Platinum based treatment did not show PFS advantage (HR 1.16, 95% CI 0.90-1.49).
Platinum-based systemic treatment is associated with increased pCR rates in patients with TNBC, hence it is a viable option for patients in the neoadjuvant setting. However, no PFS advantage was seen in patients with advanced stage treated with platinum-based regimen. Reference 1. DeVita, Hellman, and Rosenberg’s Cancer Principles and Practie of Oncology. 10th edition. 2015. 2. ASCO-SEP Medical Oncology Self-Evaluation Program. 6th edition. 2018. 3. Mylavarapu S. Role of BRCA Mutations in the Modulation of Response to Platinum Therapy. Frontiers in Oncology 2018.
1. DeVita, Hellman, and Rosenberg’s Cancer Principles and Practie of Oncology. 10th edition. 2015.
2. ASCO-SEP Medical Oncology Self-Evaluation Program. 6th edition. 2018.
3. Mylavarapu S. Role of BRCA Mutations in the Modulation of Response to Platinum Therapy. Frontiers in Oncology 2018.
Clinical trial identification
Legal entity responsible for the study
St. Luke\'s Medical Center.
Has not received any funding.
All authors have declared no conflicts of interest.