Adjuvant chemotherapy for resected triple negative breast cancer patients: A network meta-analysis

by Fausto Petrelli, Valentina Bertaglia, Maria Chiara Parati, Karen Borgonovo, Pushpamali De Silva, Andrea Luciani, Silvia Novello, Mario Scartozzi, Leisha A. Emens, Cinzia Solinas 

The Breast: Published: December 15, 2022

Abstract:

The current standard of care for resected early-stage triple negative breast cancer (TNBC) patients who did not receive systemic preoperative therapy is adjuvant anthracycline- and taxane-based chemotherapy (CT). A network meta-analysis (NMA) of randomized controlled trials (phase III) enrolling patients with resected stage I-III TNBC comparing adjuvant regimens was performed. Overall survival (OS) and disease-free survival (DFS) data were extracted. A total of 27 phase III clinical trials were selected including 15,242 TNBC patients. This NMA showed an OS benefit from the incorporation of capecitabine into classic anthracycline/taxane-based combinations compared to anthracyclines with or without taxanes alone.

Highlights:

·         The current adjuvant therapy for resected early-stage triple negative breast cancer is adjuvant chemotherapy.

·         A network meta-analysis (NMA) of randomized controlled trials was performed.

·         A total of 27 phase III clinical trials were selected including 15,242 TNBC patients.

·         Anthracycline- and taxane-plus capecitabine-based CT resulted in better OS than other regimens.

·         Similarly capecitabine-based triplets and the carboplatin/paclitaxel doublet ranked the best for DFS.

The role of CDK4/6 inhibitors in early breast cancer

 

The role of CDK4/6 inhibitors in early breast cancer

 

by Miguel Gil-Gil, Emilio Alba, Joaquín Gavilá, Juan de la Haba-Rodríguez, Eva Ciruelos, Pablo Tolosa, Daniele Candini, Antonio Llombart-Cussac 

 

The Breast: VOLUME 58, P160-169, AUGUST  01, 2021

 

The use of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) has proven to be a successful strategy in the treatment of advanced hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2 -) breast cancer (BC), leading to a strong interest in their possible role in the treatment of early luminal BC. In this review we collect the most relevant and recent information on the use of CDK4/6i for the treatment of early BC in the neoadjuvant and adjuvant settings. Specifically, we evaluate the results of the large phase 3 adjuvant trials recently released, which have yielded apparently divergent results.

Complications of Contralateral Prophylactic Mastectomy: Do They Delay Adjuvant Therapy?

 

Complications of Contralateral Prophylactic Mastectomy: Do They Delay Adjuvant Therapy?

 

by Sharabi, Safa E.; Baumann, Donald P.; Selber, Jesse C.; Killon, Elizabeth; Mericli, Alexander F.; Liu, Jun; Caudle, Abigail S.; Smith, Benjamin D.; Chavez-MacGregor, Mariana; Schaverien, Mark V.

 

Plastic and Reconstructive Surgery: November 2020 - Volume 146 - Issue 5 - p 945-953

 

Background:

There is ongoing debate regarding the optimal timing of contralateral prophylactic mastectomy fueled by concern that performing it at the time of the mastectomy for the index breast cancer may delay adjuvant therapy. The study objective was to examine the effect of simultaneous contralateral prophylactic mastectomy with immediate breast reconstruction on the complication rate and adjuvant therapy timing.

Methods:

A retrospective study was conducted of consecutive patients who underwent contralateral prophylactic mastectomy with immediate breast reconstruction and received adjuvant therapy over a 6-year period. Demographic, treatment, and outcomes data were collected, and relationships between multiple variables and outcomes were evaluated.

Results:

Of 241 patients (482 breasts) included, 186 (372 breasts) underwent simultaneous index breast mastectomy and contralateral prophylactic mastectomy with immediate breast reconstruction followed by adjuvant therapy (immediate group), and 55 (110 breasts) underwent index mastectomy, then adjuvant therapy, followed by delayed contralateral prophylactic mastectomy with immediate breast reconstruction (delayed group). Demographics were similar, although breast cancer stage (p < 0.001), tumor category (p = 0.0072), and nodal category (p < 0.001) were significantly higher in the delayed group. In the immediate group, complications before adjuvant therapy occurred in 31 patients (16.7 percent), and in six patients (3.2 percent) complications occurred only in the contralateral prophylactic mastectomy breast; delay to adjuvant therapy occurred in 11 patients (5.9 percent), in four (2.2 percent) of whom the contralateral prophylactic mastectomy breast was responsible for the delay.

Conclusions: Contralateral prophylactic mastectomy with immediate breast reconstruction can be performed safely at the time of the index mastectomy in carefully selected patients. These findings will engage patients seeking contralateral prophylactic mastectomy in shared decision-making regarding optimal timing with respect to the risks and benefits. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.