Anthracycline-free platinum-based neoadjuvant chemotherapy for triple-negative breast cancer: efficacy, safety, and clinicopathological predictors of response

Abstract

Background: triple-negative breast cancer (TNBC) is associated with aggressive tumor biology and limited systemic treatment options. Incorporation of platinum agents into neoadjuvant chemotherapy (NACT) can increase pathological complete response (pCR) rates, but platinum-based regimens containing anthracyclines are often accompanied by substantial toxicity. Anthracycline omission has therefore been proposed as a de-escalation strategy that may preserve antitumor efficacy while improving tolerability. However, evidence regarding anthracycline-free platinum-based NACT and predictors of response remains limited. Aim: to assess the efficacy and safety of an anthracycline-free platinum-based NACT regimen and to identify clinicopathological factors associated with pCR in patients with operable TNBC Materials and Methods: this prospective single-center study enrolled 50 patients with stage I–IIIA TNBC. All patients received six cycles of carboplatin AUC 5–6 plus paclitaxel 80 mg/m2 administered weekly. The primary endpoint was pCR, defined as ypT0/is ypN0. Secondary endpoints included safety, event-free survival (EFS), and analysis of predictors of response. Statistical methods included univariate and multivariate logistic regression, receiver operating characteristic (ROC) analysis, and comparative model assessment using the Akaike information criterion. Results: pCR was achieved in 60.0% of patients. After a median follow-up of 15.3 months, the 1-year EFS rate was 100%. The treatment regimen showed a favorable safety profile, with no reported cases of febrile neutropenia, grade 3–4 non-hematologic toxicity, or cardiotoxicity. BRCA1/2 mutations and higher Ki-67 levels were associated with a greater likelihood of pCR; Ki-67 remained statistically significant in multivariate analysis. Conclusion: anthracycline-free neoadjuvant chemotherapy with carboplatin plus paclitaxel demonstrated substantial efficacy and favorable tolerability in patients with operable TNBC BRCA1/2 mutation status and high Ki-67 levels were associated with pCR and may represent potential predictors of response. These results warrant further evaluation of anthracycline-free platinum-based regimens in randomized clinical trials. KEYWORDS: triple-negative breast cancer, neoadjuvant chemotherapy, pathological complete response, platinum-containing therapy, anthracycline-free regimen, BRCA1/2 mutations, Ki-67, TILs. FOR CITATION: Ratova E.I., Bolotina L.V., Kaprin A.D. Anthracycline-free platinum-based neoadjuvant chemotherapy for triple-negative breast cancer: efficacy, safety, and clinicopathological predictors of response. Russian Medical Inquiry. 2026;10(7):465–473 (in Russ.). DOI: 10.32364/2587-6821-2026-10-7-2