Neoadjuvant 4 Dose Dense Doxorubicin-Cyclophosphamide Cycles Followed by 4 Cycles of Weekly Paclitaxel and 4-Weekly Carboplatin in Locally Advanced Triple Negative Breast Cancer

Background: Triple-negative breast cancer (TNBC) needs new chemotherapy regimens to improve its poor prognosis in spite of its relative high rates of response to chemotherapy. Purpose: To study the efficacy and toxicity of a neoadjuvant chemotherapy regimen in locally advanced TNBC starting by four dose dense cycles of doxorubicin plus cyclophospha-mide followed by four cycles of weekly paclitaxel and 4 weekly carboplatin. The primary end point was pathological complete remission (pCR). The secondary end points were toxicity, relapse free survival (RFS) and overall survival (OS). Patients and Methods: Women (n=25) with unilateral breast adenocarcinoma, triple negative (lacking both estrogen and progesterone and HER 2 Neu amplification), non-inflammatory staged T3-4N0-2M0, received neoadjuvant 4 biweekly cycles of doxorubicin 60mg/m^2 and cyclophospha-mide 600mg/m^2 followed by 4 cycles of paclitaxel 80mg/m2 on days 1, 8, 15, 21 and 4-weekly carboplatin area under the curve of 6 on day 1. Cycles were supported with filgrastim. All patients had surgery with breast conservation in 44% of cases. Results: After a median follow-up of 55 months, the overall response was 96% (40% clinical complete response, 56% clinical partial response) and 32% had pCR. Five-year RFS was 68% and 5-year OS was 76%. Patients with pCR had 5-year RFS 88% and OS of 100%. Treatment was tolerable. Leucopenia G3-4 was observed in 24% of patients, febrile neutropenia in 8%, thrombocytopenia G3-4 in 12% and neuropathy G3 occurred in 4%. Conclusion: Neoadjuvant dose dense doxorubicin and cyclophosphamide followed by weekly paclitaxel and carboplatin every 4 weeks is effective and tolerable in locally advanced TNBC. However, more trials are needed to find regimen with higher pCR and higher survival outcome.