Monday, April 12, 2010

TNBC Benefits from Platinum-Based Chemotherapy

Platinum-based chemotherapy can be more effective against triple-negative breast cancer (TNBC ) tumors, according to research published in the Annals of Oncology in 2008. While this is a few years old, I am highlighting it because the research is continuing and also because the entire article is now online.

Who was studied:

541 patients who had been treated between 1991 to 2006 at the Royal Marsden Hospital in London; 19 percent had TNBC. Because TNBC was not an identified disease in the early 1990s, tumors specimens were retested for estrogen, progesterone and Her2 status. Nineteen percent of the patients—103—were identified as negative for all three, making them triple-negative. Another 155 had locally recurring or metastatic cancer; of these 22 percent, or 34 patients, were TNBC.

The results:

• Response rates for neo-adjuvant chemotherapy (done prior to other treatment) were significantly higher for TNBC tumors (88 percent ) than others (51 percent).

• The 5-year overall survival (OS) for TNBC tumors following both adjuvant and neo-adjuvant chemotherapy. however, was lower — 64 percent compared with 85 percent for others.

• Five-year disease-free survival for TNBC tumors was also lower— 57 percent compared with 72 percent for others.

• Patients with advanced breast cancer had a better overall response rate—41 percent for TNBC tumors and 31 percent for others.

• Patients with TNBC tumors had a progression-free survival of 6 months compared with 4 months for others, although the overall survival was not significantly different between the two groups (11 versus 7 months).

Treatment consisted of:

5-fluorouracil 200 mg/m2 by daily 24-h continuous infusion via a Hickman line for 18 weeks with epirubicin 60 mg/m2 i.v. and cisplatin 60 mg/m2 i.v. both repeating three weekly (infusional ECisF) for six courses as part of the adjuvant TRAFIC trial or neo-adjuvant TOPIC trial. Carboplatin was substituted for cisplatin in the event of renal toxicity, peripheral neuropathy or persistent emesis. The carboplatin dose was calculated according to renal function with an area under curve (AUC) = 5.

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