The Musc study underlines the compromises in neoadjuvant breast cancer treatment

In an interview with Pharmacy timesLACY LA FEVER, PHARMAD, MS, PGY2 Oncology Pharmacy at Medical University of South Carolina (MOSC), a study that was carried out at MOSC was discussed in which the use of a area under the curve (AUC) of 5 against an AUC of carboplatin for the treatment of breast cancer (EBC) in Frühstadium (EBC). The results of the study were presented at the 2025 HOPA annual conference in Portland, Oregon.

Pharmacy times: Can you give an overview of your presentation at Hopa? What prompted you to carry out the study?

Lacy la Fever, Pharmd, MS: One of the biggest topics in literature currently the use of an AUC of 5 for carboplatin in neoadjuvant treatment for [eBC]Compared to an AUC of 6, which was historically used. At MOSC we started implementing the AUC of 5 last year. There are still many instructions, so it is a kind of gray area whether the use of a AUC of 5 is as effective as an AUC of 6.

Since we have started and we would like to make sure that we make appropriate recommendations, we have decided to check our patient data to determine whether there are differences in safety and at the same time maintain the effectiveness when comparing an AUC of 6.

The main result we looked at was a pathological complete reaction [pCR]- At the time of the operation, there is no invasive disease in the tissue or surrounding lymph nodes. This determination is carried out after the operation, that was our main point.

We also examined toxicities – hematological toxicities such as cytopenia, anemia, neutropenia, etc. – as well as other adverse effects such as hospital stays. We have evaluated whether there was a dose reduction, as this is curative intentions. Ideally, we do not want to hold cans, reduce them or park the therapy. We want the patient to complete all planned cycles.

Ultimately, we saw a small difference in terms of the results. The dose reductions and discontinuations were more common at AUC of 6, while the AUC did not appear. In the pathological complete reaction, more patients in the AUC of the 6 group achieved this result compared to the AUC of the 5 group. So there is a little variability between the two.

Pharmacy times: How does this study inform the current carboplatin dosage practices of your institution in the future?

La fever. However, it is promised that patients receive this pathological complete reaction with fewer toxicities and fewer dose reductions. So we see how our patients complete the entire 6 cycles they need before they go to the operation.

So I think there is a few more years – like the study with a larger population, AUC 5 – to really see whether we give our patients this lower dose of carboplatin and they can get them to achieve them with less toxicity. I think there are a lot of promise. But because the population is so small, I don't think it will influence a lot at the moment.

But for patients who are a little worried – whether age or other comorbidities – that the use of a AUC of 6 could be problematic, I still think that it is okay to use an AUC of 5. I don't think it completely excludes it, but I just think that there has to be more research.

Pharmacy times: What kind of prospective data or test design do you want to see to definitely answer the question of AUC 5 against AUC 6?

La fever: I have the feeling that the pathological full reaction is probably the easiest for patients. I think a big deal that comes next is the use of the lower AUC of 5 – what about recurrence? Do we see repeatedly when it was a curative intention? How does it happen when it happens? So I have the feeling that this is later around the line when we use 5 more often, but these are probably more long -term things that we should continue.

But in most studies I really feel that the pathological complete reaction is that we assume because we know that only theoretically better results and forecast for patients who have this reaction with the neoadjuvant environment. I wouldn't change much without having more patients in the population groups to have a more even distribution.

Pharmacy times: What role can the pharmacist play in these environments?

La fever: Yes, so I think that one of the greatest things is to choose an AUC of 5 or 6, and to have this discussion with providers. If it is a young, healthy patient that you are not too concerned about, you have a higher AUC of 6 – you can still talk about it – but know which patient population could benefit from an AUC of 5 and this discussion with the provider could only have with the provider. It is still a gray area, but studies have shown fewer toxicities.

I am concerned and would like to make sure that you operate and there is no delay. So I think to have the discussion and then ultimately only to educate the patient and everything. There is no big difference between a carboplatin -sauc from 6 compared to 5, but this is the only way to think about the side effects and toxicities.