Impact of the addition of carboplatin to anthracycline‐taxane‐based neoadjuvant chemotherapy on survival in BRCA1/2‐mutated triple‐negative breast cancer

Abstract Whether adding carboplatin to standard neoadjuvant chemotherapy improves survival in BRCA1/2 ‐mutated triple‐negative breast cancer (TNBC) is unknown. In this retrospective study, we aimed to explore the efficacy of anthracycline‐taxane (A‐T)‐based or anthracycline‐taxane/carboplatin (A‐TP)‐based neoadjuvant chemotherapy in BRCA1/2 ‐mutated TNBC. A total of 1585 operable primary breast cancer patients were treated with either neoadjuvant A‐T (n = 886) or A‐TP regimen (n = 699). BRCA1 and BRCA2 germline mutations were determined in all subjects. Pathological complete response (pCR), recurrence‐free survival (RFS), distant recurrence‐free survival (DRFS) and overall survival (OS) were estimated. Of the entire cohort, 102 patients (6.4%) carried a pathogenic BRCA1/2 germline mutation. After a median follow‐up of 81 months, no significant differences in survival between the A‐T and A‐TP arms were found in the entire cohort. However, among 288 TNBC patients, BRCA1/2 mutation carriers had significantly better survival when treated with the A‐TP regimen than with the A‐T regimen (5‐year RFS: 82.6% vs 47.9%; P = .024; 5‐year DRFS: 88.5% vs 46.9%; P = .010; 5‐year OS: 88.2% vs 49.9%; P = .036). Multivariate analyses revealed that the A‐TP regimen was a significantly favourable factor for RFS and DRFS and showed a trend towards better OS when compared with the A‐T regimen in BRCA1/2 ‐mutated TNBC (RFS: adjusted hazard ratio [HR], 0.24; 95% confidence interval [CI], 0.06‐0.91, P = .035; DRFS: HR, 0.17; 95% CI, 0.03‐0.80; P = .025; OS: HR, 0.29; 95% CI, 0.06‐1.49; P = .14). Our study suggested that BRCA1/2‐ mutated TNBC patients gain a survival benefit when carboplatin is added to standard A‐T‐based neoadjuvant chemotherapy.