BREAST CANCER: NEOADJUVANT TREATMENT
Triple Negative
Cesar A. Rodriguez
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Introduction 7 16 0 10 20 30 40 50 60 18 30 31 50. Grade 1-2 Grade 3 HR +
No After Yes After
HER2+ HR+
No After Yes After
HER2+ HR- TRIPLE NEG
34
pCR Rates by Tumor Subtypes
–(3)(4)(5)(6)(7)
Introduction
It is necessary to incorporate into Neoadjuvant treatment schemes that increase the percentage of pCR
–(8)
Introduction
It is necessary to incorporate into Neoadjuvant treatment schemes that increase the percentage of pCR
You need to design
strategies that improve the prognosis of patients who do NOT achieve pCR
–(9)
Introduction
It is necessary to incorporate into Neoadjuvant treatment schemes that increase the percentage of pCR
You need to design
strategies that improve the prognosis of patients who do NOT achieve pCR
–(10)(11)
Neoadjuvant CT in CMTN and Platinum derivatives
–(12)(13)
Neoadjuvant CT in CMTN and Platinum derivatives
Stages II-III RE & PR <10% HER2 neg. N 443
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Neoadjuvant CT in CMTN and Platinum derivatives
Update DFS data in SABCS ’15
TO
BC
S
20
15
–(16)
Neoadjuvant CT in CMTN and Platinum derivatives
Selection of Biomarkers (BRCA status)
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S2-04 EARLY SURVIVAL ANALYSIS OF THE RANDOMIZED PHASE II TRIAL INVESTIGATING THE ADDITION OF CARBOPLATIN TO NEOADJUVANT THERAPY FOR
TRIPLE-NEGATIVE AND HER2-POSITIVE EARLY BREAST CANCER (GEPARSIXTO) Speaker: Gunter von Minckwitz
Slide 13 / 17
Slide 14 / 17
Page 7
From Minckwitz G, et al. SABCS 2015
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Neoadjuvant CT in CMTN and Platinum derivatives
Selection of Biomarkers (BRCA status)
From Minckwitz G, et al. SABCS 2015
GeparSixto
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S2-04 EARLY SURVIVAL ANALYSIS OF THE RANDOMIZED PHASE II TRIAL INVESTIGATING THE ADDITION OF CARBOPLATIN TO NEOADJUVANT THERAPY FOR
TRIPLE-NEGATIVE AND HER2-POSITIVE EARLY BREAST CANCER (GEPARSIXTO) Speaker: Gunter von Minckwitz
Slide 15 / 17
Slide 16 / 17
Page 8
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S2-04 EARLY SURVIVAL ANALYSIS OF THE RANDOMIZED PHASE II TRIAL INVESTIGATING THE ADDITION OF CARBOPLATIN TO NEOADJUVANT THERAPY FOR
TRIPLE-NEGATIVE AND HER2-POSITIVE EARLY BREAST CANCER (GEPARSIXTO) Speaker: Gunter von Minckwitz
Slide 15 / 17
Slide 16 / 17
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Neoadjuvant CT in CMTN and Platinum derivatives
Selection of Biomarkers (BRCA status)
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Neoadjuvant CT in CMTN and Platinum derivatives
Selection of Biomarkers (BRCA status)
by Gunter von Minckwitz, MD.
Slides and presented data is the property of GBG.
Permission required for reuse.
pCR Rates by Treatment Arms
(ypT0 ypN0)
20.0% 33.9%
0%
20%
40%
60%
80%
100%
HR non-deficient HR deficient
PM
63.5%
29.6%
0%
20%
40%
60%
80%
100%
HR non-deficient HR deficient
PMCb
OR 2.05 (0.73-5.78)
P=0.162
OR 4.13 (1.60 – 10.71)
P=0.002
N=30 N=62 N=27 N=74
Test for interaction p=0.327
GeparSixto
Y
HR Score
–(20)(21)(22)(23)(24)
Neoadjuvant CT in CMTN and Bevacizumab
Docetaxel
S
u
r
g
e
r
Y
AC x 4
Cycles 1‒3 4‒6
+/- Bevacizumab
C
B
A
Docetaxel + Cape AC x 4
+/- Bevacizumab
Docetaxel + Gem AC x 4
+/- Bevacizumab
+/- Drink x 10 cycles
T > 2 cm
N0-2a
HER2 –
(n = 1206)
TN: 490 pts (41%)
–(25)
Neoadjuvant CT in CMTN and Bevacizumab
–(26)(27)
Neoadjuvant CT in CMTN and Bevacizumab
–(28)(29)(30)
Neoadjuvant CT in CMTN and Nab-Paclitaxel
N=1200
Sure
ger
Y
12 weeks – 12 administrations 12 weeks
Paclitaxel 80 mg/m2 QW
Epirubicin 90 mg/m2
Cyclophosphamide 600 mg/m2
Nab-paclitaxel 150 mg/m2 QW (amended
to 125 mg/m2 QW May 2013)
Cyclophosphamide 600 mg/m2
Epirubicin 90 mg/m2R
HER2 –
HER2 –
Trastuzumab 8 mg/kg (loading dose) followed by 6 mg/kg
Pertuzumab 840 mg (loading dose) followed by 420 mg
HER2 +
Trastuzumab 8 mg/kg (loading dose) followed by 6 mg/kg
Pertuzumab 840 mg (loading dose) followed by 420 mg
HER2 +
–(31)(32)
Neoadjuvant CT in CMTN and Nab-Paclitaxel
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Neoadjuvant CT in CMTN and Nab-Paclitaxel
Presented By Luca Gianni at 2016 ASCO Annual Meeting
Scheme of the Phase III randomized ETNA trial
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Neoadjuvant CT in CMTN and Nab-Paclitaxel
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Neoadjuvant CT in CMTN and Nab-Paclitaxel
Gluz O, Harbeck N, ASCO 2015
Efficacy of 12 weeks neoadjuvant nab-Paclitaxel combined
with Carboplatinum vs Gemcitabine in triple negative
–(36)
Neoadjuvant CT in CMTN and Nab-Paclitaxel
Gluz O, Harbeck N, ASCO 2015
pCR : 36%
25% vs 49,5% (p:0,006)
Efficacy of 12 weeks neoadjuvant nab-Paclitaxel combined
with Carboplatinum vs Gemcitabine in triple negative
–(37)
Neoadjuvant CT in CMTN. Conclusions PLATINUM DERIVATIVES BEVACIZUMAB NAB-PACLITAXEL pCR DFS
☐☐
☐
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Neoadjuvant CT in CMTN. Conclusions PLATINUM DERIVATIVES BEVACIZUMAB NAB-PACLITAXEL pCR DFS
☐☐
☐
Nab-PACLITAXEL + CARBOPLATINO
☐
–(39)
It is necessary to incorporate into Neoadjuvant treatment schemes that increase the percentage of pCR
You need to design
strategies that improve the prognosis of patients who do NOT achieve pCR
–(40)
It is necessary to incorporate into Neoadjuvant treatment schemes that increase the percentage of pCR
You need to design
strategies that improve the prognosis of patients who do NOT achieve pCR
–(41)
Strategies in patients WITHOUT pCR
Lee SJ, SABCS 2015
298 pts (33%) TN
–(42)
Strategies in patients WITHOUT pCR
–(43)(44)(45)
