Tailored preoperative treatmnet of locally advanced triple negative (hormone receptor negative and HER2 negative) breast cancer with epirubicin, cisplatin, and infusional fluorouracil followed by weekly paclitaxel

Background: No specific treatment guidelines are available for triple-negative breast cancers, defined by a lack of expression of estrogen (ER), progesterone (PgR), and HER2 receptors. Patients and methods: We investigated in patients with T2-T3 N0-3 ER, PgR <10% and HER2 negative breast cancers the activity both in terms of pathological (pCR) and objective responses of four courses of cisplatin containing chemotherapy (ECF, epirubicin, cisplatin, and fluorouracil as continuous infusion) followed by three courses of weekly paclitaxel. Adjuvant metronomic chemotherapy including cyclophosphamide and methotrexate for 4-6 months was administered. Results: Thirty patients are evaluable. Median age was 41 years (28-64 years). Twenty-three of 25 evaluable tumors stained positively for epidermal growth factor receptor. An objective response, either complete and partial, was observed in 26 patients (86, 95% CI 69.3-96.2%). and a pCR was obtained in 12 patients (40, 95% CI 22.7-59.4%). Two patients progressed during paclitaxel. Negative axillary nodes were found in 80% (95% CI 61.4-92.3%) of patients at surgery. Twenty-six patients (86, 95% CI 61.4-92.3%) underwent breast conserving surgery. Grade >2 non-hematological toxicity was observed in three and two patients during ECF and paclitaxel, respectively. The 2-year disease free survival (DFS) was 87.5% (95% CI 74.7-100%). No significant correlation was observed between EGFR staining and either pCR or DFS. Conclusions: Preoperative cisplatin containing chemotherapy followed by paclitaxel induced an high pCR rate in a population of triple-negative breast cancer. The impact of this schedule on long-term outcome should be investigated in larger series.