Triple‐negative breast cancer: multipronged approach, single‐arm pilot phase II study

Anthracyclines ( A ) and taxanes ( T ) are standard first‐line chemotherapy agents for patients with advanced breast cancer. Platinum analogues have also shown activity in the triple‐negative breast cancer ( TNBC ) histology, but clinical data are limited. Here we report the long‐term follow‐up of a phase II study on TNBC treated with a combined modality therapy, including induction with AT , cyclophosphamide, methotrexate, and 5‐fluorouracil ( CMF ) with concurrent radiation therapy, and a dose‐dense consolidation chemotherapy ( HDCT ) with carboplatin ( CBDCA ), ifosfamide ( IFX ), etoposide ( VP‐16 ). Patients' median age was 44 years, with 73% premenopausal. Epirubicin 75 mg/m 2 and docetaxel 75 mg/m 2 were administered to 70 patients with TNBC : as neoadjuvant and adjuvant therapy to 12 and 58 patients, respectively. Postoperative radiation therapy, 5000 cG y, was delivered, synchronous with triweekly CMF . After radiation therapy, two courses of HDCT with CBDCA , IFX , VP‐16 , were given, with hematological growth factors. After a median follow‐up of 81 months, all patients were evaluable for toxicity and response. Most important toxicity were grade 3 skin reaction and grade 4 hematological in 3% and 31% of patients, respectively. Pathological complete response was observed in 25% of patients receiving preoperative chemotherapy. Treatment failures were as follows: eight visceral, four contralateral breast cancer, four locoregional, and one leukemia. Five‐year progression‐free survival and overall survival rate were 78% and 91%, respectively. Induction chemotherapy, followed by chemoradiation therapy and HDCT , provides a prolonged disease‐free period and a significant increase in overall survival in TNBC , with an acceptable toxicity profile.