Tumor-Infiltrating Lymphocytes and Response to Platinum in Triple-Negative Breast Cancer
Menée sur 580 patientes atteintes d'un cancer primitif du sein HER2+ ou triplement négatif, cette étude évalue l'association entre le niveau de lymphocytes infiltrant la tumeur, l'expression de 12 ARNs messagers impliqués dans l'activation ou la suppression de processus du système immunitaire et la réponse à une chimiothérapie néoadjuvante avec ou sans carboplatine
Platinum has received much attention recently for the treatment of newly diagnosed triple-negative breast cancer (TNBC). Two randomized phase II neoadjuvant trials, GeparSixto and CALGB (Cancer and Leukemia Group B) 40603 (Alliance), reported that pathologic complete response (pCR) rates were approximately 15% higher with the addition of carboplatin to anthracyclines and taxanes.1,2 GeparSixto randomly assigned patients with TNBC to once-per-week paclitaxel and liposomal doxorubicin, with or without once-per-week carboplatin, for 18 weeks. Patients also received bevacizumab. The pathologic complete response (pCR) rate in patients with TNBC in the breast and axilla was significantly higher with the addition of carboplatin (53.2% v 36.9%; P = .005). CALGB 40603(Alliance) also demonstrated an increased pCR rate in stage II and III TNBC with the addition of carboplatin (once every 3 weeks for four cycles) to paclitaxel and dose-dense doxorubicin and cyclophosphamide (54% v 41%; P = .0029). Despite the higher pCR rates, neither study has reported a significant increase in the rate of breast conservation, and there is no long-term follow-up to assess the impact of platinum on either disease-free or overall survival. Even if we conclude that the platinum salts have a role in TNBC, it is not clear whether these agents should be added to current regimens or replace existing drugs.
Journal of Clinical Oncology , éditorial en libre accès, 2015