In Reply We would like to thank Arora et al for their interest in our PATTERN (adjuvant Platinum and Taxane in Triple-Negative Breast Cancer) randomized clinical trial1 and their thoughtful comments on the article. First, we agree with their statement that “the PATTERN trial adds to the evidence that an anthracycline-free regimen may be considered for patients with node-negative TNBC [triple-negative breast cancer] treated with up-front surgery.” Currently, neoadjuvant chemotherapy is widely used for patients with TNBC, especially for those with node-positive disease. Based on the results of the CREATE-X (Capecitabine for Residual Cancer as Adjuvant Therapy) trial,2 neoadjuvant chemotherapy is recommended for patients with TNBC because it will allow us to identify the subset of patients who do not achieve pathologic complete response (pCR) and may benefit from additional treatment with capecitabine. However, there is concern regarding the overuse of neoadjuvant chemotherapy in patients with primary breast cancer and the drawbacks of neoadjuvant therapy because the addition of capecitabine is not based on the concept of precision medicine, but on the traditional concept that a more intensive and extended chemotherapy regimen will be beneficial for TNBC. The neoadjuvant strategy may uncover patients with non-pCR tumors who are insensitive to anthracycline/taxane-containing neoadjuvant chemotherapy, but it does not help us find subsequent effective and sensitive therapeutic regimens. In other words, neoadjuvant therapy identifies the insensitive subgroup but does not reveal the underlying mechanism of chemotherapy resistance.
Yu K, Shao Z. Effect of Adjuvant Paclitaxel and Carboplatin on Survival in Early Triple-Negative Breast Cancer—Reply. JAMA Oncol. 2021;7(3):461. doi:10.1001/jamaoncol.2020.7160
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