The phase 3 PEARLY trial (NCT02441933) has provided robust evidence supporting the addition of carboplatin to anthracycline and taxane-based therapy for patients with early-stage triple-negative breast cancer (TNBC). The study demonstrated a significant improvement in event-free survival (EFS) with the addition of carboplatin, potentially establishing it as a more effective treatment option for this aggressive form of breast cancer. After a median follow-up of 51.1 months, patients who received carboplatin in combination with the chemotherapy regimen had significantly improved event-free survival (EFS) compared with those who received standard chemotherapy alone (HR, 0.68; 95% CI, 0.50-0.93; P = 0.017). The 5-year EFS rate for the carboplatin arm was 81.9%, a 7.5% improvement over the control group’s rate of 74.4%.
Impact on Clinical Practice
According to Vered Stearns, MD, director of Translational Breast Cancer Research at Weill Cornell Medical School, the PEARLY study helps inform treatment decisions. "The PEARLY study helps us as we move forward with this regimen, knowing that carboplatin added to anthracycline/taxane [regimens enhances] disease-free and overall survival benefit [for] patients with triple-negative breast cancer," she stated.
Study Design and Results
The PEARLY trial aimed to determine whether carboplatin provides additional benefit when combined with anthracycline/taxane-based therapy versus anthracycline/taxanes alone as either neoadjuvant or adjuvant treatment in early-stage TNBC. The primary endpoint was event-free survival. Secondary endpoints included invasive disease-free survival and distant recurrence-free survival, all of which favored the carboplatin-containing regimen.
A subgroup analysis revealed consistent benefits across various patient categories, further strengthening the evidence that carboplatin offers a survival advantage.
Current Treatment Landscape and the Role of Carboplatin
While platinum-based chemotherapy agents are often used in neoadjuvant therapy for early-stage TNBC and improve response rates, the survival benefit has remained inconclusive. The PEARLY study addresses this uncertainty, providing evidence of a significant survival advantage with the addition of carboplatin. The findings reinforce the role of carboplatin in improving survival outcomes for patients with early-stage TNBC.
