Dag nab.

Top Line: Does it matter whether the “T” in neoadjuvant chemo for locally-advanced breast cancer stands for paclitaxel or its much fancier cousin nab-paclitaxel (aka Abraxane)? 
The Study: While the ETNA trial of nearly 700 women with HER2(-) breast cancer failed to find any significant difference with subbing in Abraxane—other than increased peripheral neuropathy, that is—final reporting of the similarly-designed GeparSepto trial of over 1200 women with all subtypes shows consistent improvements. Here pathologic complete response (pCR) rates were higher with Abraxane across molecular subtypes, particularly in the triple-negative subset where it was nearly doubled from 26 → 48%. What’s more, these eventually translated to consistent slashes in disease recurrences by one-third with pretty consistent invasive disease-free survival (iDFS) hazard ratios of 0.67. That means, among the triple-negative subset, there was an absolute iDFS advantage at 4 years of almost 10% (70 → 79%). Without surprise, women with a pCR had only a fraction of the disease recurrences. More interesting, women without a pCR saw similar improvements in iDFS with Abraxane (HR 0.67). However, this all didn’t come without cost (literally and figuratively), as there was nearly 2-3x more G2-3+ peripheral neuropathy with Abraxane.
TBL: The biggest most inclusive data out there indicates substituting neoadjuvant paclitaxel with Abraxane offers consistent relative reductions in invasive disease-free survival across breast cancer subtypes. | Untch, J Clin Oncol 2019

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