More uncertainty about BRCA-related platinum chemotherapy for breast cancer.

This article is from the NEJM journal watch more uncertainty about platinum chemotherapy for BRCA associated breast cancer by William J. Gradishar, MD, compared with doxorubicin combined with cyclophosphamide, cisplatin failed to improve the pathological complete response rate.the effect of platinum chemotherapy on BRCA mutant breast cancer and triple negative breast cancer (TNBC) is still controversial.TNT (NAT Med 2018; 24:628) and other trials have shown that platinum drugs (carboplatin) has a clinical advantage over paclitaxel (docetaxel) in BRCA related TNBC patients, but not in other TNBC patients.however, geparsixto test (NEJM JW Oncol Hematol SEP 2014 and lancet Oncol 2014 Jun; 15:747 and NEJM JW Oncol Hematol SEP 2017 and JAMA Oncol 2017; 3: 1378) showed that the addition of platinum drugs (carboplatin) to neoadjuvant therapy of paclitaxel, anthracycline and antiangiogenic agent (bevacizumab) did not significantly improve the pathological complete response rate (PCR) in patients with HER2 + or BRCA associated TNBC disease.to further evaluate the efficacy of platinum based chemotherapy on BRCA mutation carriers, a multicenter, randomized, phase 2 trial (inform) was conducted in 117 patients with BRCA related stage I-III her Four cycles of neoadjuvant cisplatin chemotherapy and doxorubicin combined with cyclophosphamide neoadjuvant chemotherapy were compared in 2-breast cancer patients (70% of them had TNBC).the PCR rate of cisplatin group was lower than that of AC group (18% vs. 26%; risk ratio, 0.7), and the proportion of patients with residual lesion load score of 0 or 1 was lower than that of AC group (33% vs. 46%; risk ratio, 0.73).commenting on these findings, it is further demonstrated that platinum does not outperform the AC regimen in the preoperative treatment of BRCA associated breast cancer, whether TNBC, HER2 + or her 2 -.other factors should be considered when choosing chemotherapy drugs, including the patient's tolerance to different chemotherapy regimens.based on the limited data available, PARP inhibitors (alone or in combination with chemotherapy) may be a promising new adjuvant therapy for this patient population.reviewed article Tung n et al. Tbcrc 031: randomized phase II study of neoadjuvant cisplatin versus doxorubicin cyclophosphamide in germline BRCA carriers with HER2 negative breast cancer (the information trial). J Clin Oncol 2020 May 10; NEJM journal watch is published by NEJM group. Famous international doctors are invited to comment on important papers in medical field to help doctors understand and apply the latest progress.NEJM medical frontier translated several articles every week, published on app and official website, and selected 2-3 articles to be published on wechat.this article is translated, compiled or invited by the editorial department of NEJM medical frontier.for translation and writing articles originated from English products of NEJM group, the original English version shall prevail.the full text of the Chinese translation and the charts included are exclusively authorized by the NEJM group of the Massachusetts Medical Association.please contact nejmqianyan@nejmqianyan.cn 。unauthorized translation is an infringement, and the copyright owner reserves the right to investigate the legal liability.