The impact of carboplatin on pathologic complete response and survival based on HER2 low and HER2 zero status in triple negative breast cancer patients receiving neoadjuvant chemotherapy: a multicenter real-world analysis

Abstract

Background and Objectives Triple-negative breast cancer (TNBC) has a poor prognosis, and neoadjuvant chemotherapy (NACT) is the standard treatment for locally advanced TNBC. In this study, we aimed to evaluate the efficacy of adding carboplatin to NACT regarding pathological complete response (pCR) and survival in the HER2-low and HER2-zero subgroups of TNBC patients. Materials and Methods The study included 269 patients from five medical oncology clinics. Patients were divided into two groups: HER2-low (n = 152, 56.5%) and HER2-zero (n = 117, 43.5%). Among HER2-zero patients, 30 (25.6%) received carboplatin, while 38 (25.0%) HER2-low patients received carboplatin. The benefit of adding carboplatin to NACT regarding pCR and survival was assessed in both HER2-zero and HER2-low groups. Results When patients were evaluated according to HER2 status, the pCR rates were significantly higher in the HER2-zero group compared to the HER2-low group (45.2% versus 23.7%, p < 0.001). In the HER2-zero group, patients who received carboplatin had significantly higher pCR rates (63.3% versus 39.0%, p = 0.021). Similarly, in the HER2-low group, adding carboplatin significantly increased the pCR rates (36.8% versus 19.3%, p = 0.028). While carboplatin improved pCR rates in both HER2 subgroups, this benefit was not observed in patients with Grade 1 tumors, HER2 score 2-FISH negative tumors, or based on BRCA mutation status. Patients with pCR exhibited significantly prolonged DFS and OS (p = 0.002, p < 0.001, respectively). Conclusions Our research demonstrates that the addition of carboplatin increases pCR rates in both HER2-zero and HER2-low patient cohorts. We suggest that carboplatin should be considered as an addition to standard neoadjuvant chemotherapy for eligible TNBC patients, regardless of HER2-zero or HER2-low status, when appropriate based on individual patient factors and toxicity considerations.