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Efficacy of Platinum Chemotherapy vs Capecitabine for Basal-Like Triple-Negative Breast Cancer


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About 80% of triple-negative breast cancers are classified as the subtype basal-like. Typically, patients with triple-negative breast cancer receive chemotherapy before surgery. The presence of residual cancer in the breast after chemotherapy signals a higher likelihood that the cancer will progress after surgery. A previous clinical trial demonstrated that additional capecitabine chemotherapy after surgery helps decrease the chance of disease recurrence. Yet, although capecitabine helps, researchers do not know whether treatment with different chemotherapy drugs could have the same or better results than capecitabine. Other research showed that basal-like triple-negative breast cancers are more sensitive to platinum chemotherapies that damage DNA.

Ingrid A. Mayer, MD

Ingrid A. Mayer, MD

At the 2021 ASCO Annual Meeting, Ingrid A. Mayer, MD, and colleagues presented data from study EA1131, a randomized phase III clinical trial conducted to assess whether platinum chemotherapy would be as effective or more effective than capecitabine in basal-like triple-negative breast cancers. The study was for patients in a very high-risk group: those who had basal-like triple-negative breast cancer that was still present after initial chemotherapy. Patients were randomly assigned to one of two treatment groups after receiving standard chemotherapy and surgery. The first group received capecitabine chemotherapy after surgery. The second group received a platinum chemotherapy—either cisplatin or carboplatin—after surgery.

After a recent interim analysis, the EA1131 trial was stopped early by the ECOG-ACRIN Data and Safety Monitoring Committee. The interim analysis showed it was unlikely that platinum chemotherapy would be any better than standard capecitabine chemotherapy at preventing recurrence in patients with residual basal-like triple-negative breast cancer following neoadjuvant chemotherapy.

While platinum chemotherapy has been routinely adopted by many to treat basal-like triple-negative breast cancer still present after initial chemotherapy, the results of the randomized phase III trial EA1131 show that it should no longer be used in this setting.
— Ingrid A. Mayer, MD

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First author Dr. Mayer, of Vanderbilt-Ingram Cancer Center, commented, "While platinum chemotherapy has been routinely adopted by many to treat basal-like triple-negative breast cancer still present after initial chemotherapy, the results of the randomized phase III trial EA1131 show that it should no longer be used in this setting. The group of women in the trial who received platinum chemotherapy had more serious side effects than those who received the standard chemotherapy drug capecitabine." Overall incidence of any toxicity was similar (83% with platinum, 80% with capecitabine), but grade 3 and 4 toxicities (no grade 5) were more common with platinum (25% vs 15%).

Disclosure: For full disclosures of the study authors, visit coi.asco.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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