Aumilto Silva, Medical Oncologist and Clinical Research at Hospital Santa Catarina Paulista, shared a post on X about a paper by Hong-Fei Gao et al. published in the Journal of Clinical Oncology:
“neoCARHP (Phase III): Can we omit carboplatin in neoadjuvant HER2+ breast cancer?
- Population: Stage II–III HER2+ breast cancer (n=774; mITT n=766)
- Design: Randomized noninferiority
- Arms (6 cycles q3w):
THP (taxane + trastuzumab + pertuzumab) vs TCbHP (taxane + carboplatin + trastuzumab + pertuzumab)
- Primary endpoint (pCR ypT0/is ypN0):
- THP: 64.1% (245/382)
- TCbHP: 65.9% (253/384)
Difference –1.8% (95% CI –8.5 to 5.0) → THP noninferior (P_noninferiority=0.0089)
By HR status:
- HR+ pCR: 55.8% (THP) vs 58.8% (TCbHP)
- HR– pCR: 78.2% (THP) vs 77.8% (TCbHP)
Safety advantage (THP better tolerated):
- Grade 3–4 AEs: 20.7% vs 34.6%
- Serious AEs: 1.3% vs 4.7%
- Less hematologic toxicity (e.g., neutropenia 6.8% vs 16.4%, leukopenia 5.5% vs 14.8%)
Strengths: large randomized phase III, clear noninferiority design, high pCR (~64–66%), better tolerability with THP.
Limitations/caveats:
- Primary endpoint = pCR, survival (EFS/OS) is still immature
- Taxane choice investigator-selected + docetaxel dose imbalance (100 vs 75 mg/m²) may confound efficacy/toxicity attribution
- Mostly Chinese population and a higher proportion of stage II / N0 → generalizability uncertain
- q3w paclitaxel/nab-paclitaxel schedule not standard in many regions
Can we move forward? I think, in most patients, yes.”
Title: Neoadjuvant Taxane Plus Trastuzumab and Pertuzumab With or Without Carboplatin in Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer: The Randomized Noninferiority Phase III neoCARHP Trial
Authors: Hong-Fei Gao, Guo-Lin Ye, Ying Lin, Qin Huang, Jie Dong, Yin Cao, Yan-Xia Zhao, Qian-Jun Chen, Shi-Hui Ma, Jie Ouyang, Jin-Hui Ye, Hua-Wei Yang, Yuan-Qi Zhang, Yong-Cheng Zhang, Gang-Ling Zhang, Wei Li, Yunjian Zhang, Zhi-Yong Wu, Ying-Yi Lin, Teng Zhu, Liu-Lu Zhang, Ci-Qiu Yang, Mei Yang, Hao Peng, Bo Chen, Yi-Tian Chen, Fei Ji, Min-Yi Cheng, Jie-Qing Li, Zefei Jiang, and Kun Wang
You can read the Full Article in the Journal of Clinical Oncology.
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