Comparative Analysis between an Anthracycline Based Regimen and a Platin Based Regimen in Neoadjuvant Setting for Triple-negative Breast Cancer: A Single Institutional Retrospective Study

Objective: This study was designed to comparatively analyse the response and survival between Carboplatin plus Paclitaxel (TP) vs. 5FU plus Epirubicin plus Cyclophosphamide (FEC) in ER, PR and HER-2 neu negative Breast Cancer patients of locally advanced breast cancer (LABC), large operable breast cancer (LOBC) and selected early breast cancer (EBC) patients as Neoadjuvant Chemotherapy (NACT).

Methods: In this single institutional retrospective study total 73, AJCC 7th Stage group IIB ∼ IIIB, TNBC patients were included. Patients received 6 cycles of either Inj. Paclitaxel 175 mg/m2 IV plus Inj. Carboplatin at an AUC 5 IV on day1, every 21 days or Inj. 5FU 500 mg/m2 IV plus Inj. Epirubicin100 mg/m2 IV plus Inj. Cyclophosphamide 500 mg/m2 IV on day1, every 21 days. Response was assessed after 6 cycles using RECIST v1.1. Modified Radical Mastectomy (MRM) and adjuvant Post Mastectomy Radiation Therapy (PMRT) were done as and when indicated. Survival benefit was comparatively analysed in terms of median progression free survival (mPFS) and Overall Survival (OS).

Results: Out of total 73 Triple-negative Breast Cancer(TNBC) patients 37 (3 EBC, 11 LOBC and 23 LABC) received FEC and 36 (2 EBC, 13 LOBC and 21 LABC) received TP. Age, menopausal status and number of first/second degree relatives affected, Nottingham Prognostic Index (NPI) were closely comparable for both arms. MRM could be done in 62.2% (FEC) and 86.1% (TP) patients (p value 0.020). Post- NACT pathological T0 (ypT0) was achieved in 13.5% & 41.7% patients of FEC and TP arms, respectively (p value 0.007). Complete response (CR) and partial response (PR) were achieved in 13.5% and 43.2% (FEC arm) vs. 33.3% and 63.9% (TP arm); p value 0.001. mPFS was 13 months(FEC) vs. 17 months(TP) (p value 0.001). No significant difference in terms of severe hematological toxicities was found (21.6% Vs 22.2%, p=0.61) though neurological toxicities were slightly more common in TP arm.

Conclusion: Platin-taxane combination chemotherapy was proven promising over anthracycline-based combination chemotherapy in neo-adjuvant setting while treating TNBC of various stages in terms of efficacy considering tolerable toxicity profile.