De-escalated Neoadjuvant Chemotherapy in Early Triple-Negative Breast Cancer (TNBC): Impact of Molecular Markers and Final Survival Analysis of the WSG-ADAPT-TN Trial

Gluz, Oleg; Nitz, Ulrike; Kolberg-Liedtke, Cornelia; Prat, Aleix; Christgen, Matthias; Kuemmel, Sherko; Mohammadian, Mohammad Parsa; Gebauer, Daniel; Kates, Ronald; Pare, Laia; Grischke, Eva-Maria; Forstbauer, Helmut; Braun, Michael; Warm, Mathias; Hackmann, John; Uleer, Christoph; Aktas, Bahriye; Schumacher, Claudia; Wuerstlein, Rachel; Graeser, Monika; Pelz, Enrico; Jozwiak, Katarzyna; Zu Eulenburg, Christine; Kreipe, Hans Heinrich und Harbeck, Nadia (2022): De-escalated Neoadjuvant Chemotherapy in Early Triple-Negative Breast Cancer (TNBC): Impact of Molecular Markers and Final Survival Analysis of the WSG-ADAPT-TN Trial. In: Clinical Cancer Research, Bd. 28, Nr. 22: S. 4995-5003

Abstract

Purpose: Although optimal treatment in early triple-negative breast cancer (TNBC) remains unclear, de-escalated chemother-apy appears to be an option in selected patients within this aggressive subtype. Previous studies have identified several pro -immune factors as prognostic markers in TNBC, but their predictive impact regarding different chemotherapy strategies is still controversial.Experimental Design: ADAPT-TN is a randomized neoadju-vant multicenter phase II trial in early patients with TNBC (n = 336) who were randomized to 12 weeks of nab-paclitaxel 125 mg/m2 thorn gemcitabine or carboplatin d 1,8 q3w. Omission of further (neo-) adjuvant chemotherapy was allowed only in patients with patho-logical complete response [pCR, primary endpoint (ypT0/is, ypN0)]. Secondary invasive/distant disease-free and overall survival (i/dDFS, OS) and translational research objectives included quantification of a predictive impact of markers regard-ing selection for chemotherapy de-escalation, measured by gene expression of 119 genes (including PAM50 subtype) by nCounter platform and stromal tumor-infiltrating lymphocytes (sTIL).Results: After 60 months of median follow-up, 12-week-pCR was favorably associated (HR, 0.24;P = 0.001) with 5y-iDFS of 90.6% versus 62.8%. No survival advantage of carboplatin use was observed, despite a higher pCR rate [HR, 1.04;95% confidence interval (CI), 0.68-1.59]. Additional anthracycline-containing che-motherapy was not associated with a significant iDFS advantage in pCR patients (HR, 1.29;95% CI, 0.41-4.02). Beyond pCR rate, nodal status and high sTILs were independently associated with better iDFS, dDFS, and OS by multivariable analysis.Conclusions: Short de-escalated neoadjuvant taxane/platinum-based combination therapy appears to be a promising strategy in early TNBC for using pCR rate as an early decision point for further therapy (de-) escalation together with node-negative status and high sTILs.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1078-0432
• Sprache: Englisch