Veliparib-carboplatin combo is first 'graduate' of I-SPY2 trial

I would like to congratulate the first graduate from the I-SPY 2 trial.

The efficacy results with neoadjuvant carboplatin in the Cancer and Leukemia Group B (CALGB) 40603 trial, also presented at the symposium, are consistent with the I-SPY 2 prediction, with carboplatin really increasing pCR rates in triple-negative disease although direct cross-trial comparison is limited.

The rate of pCR was very similar, about 50%, in both trials with carboplatin-containing chemotherapy even though the former trial did not use veliparib. This suggests the contribution of veliparib is modest if any in this particular patient population.

What further complicates the interpretation is that the activity of veliparib is likely influenced by germline BRCA status and may also be dependent on the extent of somatic homologous DNA recombination defects in the tumor.

Two ongoing randomized trials will be especially important to clarifying the role of neoadjuvant veliparib in triple-negative breast cancer among BRCA carriers. Until these results are available, the value of veliparib to increase pCR rate in triple-negative disease remains uncertain.

Dr. Lajos Pusztai is with the Yale Cancer Center and Smilow Cancer Hospital in New Haven, Connecticut. He was the official discussant to the paper at the meeting.