Skip to main content

Advertisement

SpringerLink
Log in

A phase II trial of dose-dense (biweekly) paclitaxel plus carboplatin as neoadjuvant chemotherapy for operable breast cancer

  • Clinical trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

The aim of the present study is to investigate the efficacy and safety of dose-dense (biweekly) carboplatin and paclitaxel as a neoadjuvant treatment for operable breast cancer. Patients with previously untreated breast cancer (stages Ic–III) were treated with four cycles of paclitaxel (175 mg/m2, intravenous drip, D1) and carboplatin (area under the curve of 5, D1). Patients with HER2+ disease simultaneously received trastuzumab (6 mg/kg initial dose with subsequent doses of 4 mg/kg biweekly). The primary endpoint was a pathologically complete response (pCR). Between January 2012 and February 2014, 110 patients were enrolled. The overall pCR rate was 35.45 % (39 of 110). The pCR rates for the different cancer subtypes were as follows: 10.53 % (2 of 19) among the patients with the luminal A subtype, 12.50 % (5 of 40) among the patients with the luminal B (HER2−) subtype, 58.33 % (14 of 24) among the patients with the luminal B (HER2+) subtype, 57.14 % (8 of 14) among the patients with the triple-negative subtype, and 76.92 % (10 of 13) among the patients with the HER2+ subtype. The patients experienced the following toxicity side effects: grade 3/4 neutropenia (N = 27, 24.55 %), grade 3/4 anemia (N = 6, 5.45 %), grade 3/4 thrombocytopenia (N = 2, 1.82 %), grade 3 alanine aminotransferase (ALT) elevation (N = 1, 0.91 %), grade 3 neuropathy (N = 3, 2.73 %), grade 3 pain (N = 2, 1.82 %), and grade 3 fatigue (N = 1, 0.91 %). In total, 19.09 % of the patients experienced treatment delay or discontinuation due to hematological toxicity, and one patient discontinued treatment due to non-hematological toxicity. Neoadjuvant biweekly paclitaxel plus carboplatin is a feasible therapy that achieved high pCR rates in patients with the HER2+, triple-negative, and luminal B (HER2+) cancer subtypes (NCT0205986).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Earl HM, Hiller L, Dunn JA, Blenkinsop C, Grybowicz L, Vallier AL, Abraham J, Thomas J, Provenzano E, Hughes-Davies L, Gounaris I, McAdam K, Chan S, Ahmad R, Hickish T, Houston S, Rea D, Bartlett J, Caldas C, Cameron DA, Hayward L, Investigators AR (2015) Efficacy of neoadjuvant bevacizumab added to docetaxel followed by fluorouracil, epirubicin, and cyclophosphamide, for women with HER2-negative early breast cancer (ARTemis): an open-label, randomised, phase 3 trial. Lancet Oncol 16(6):656–666. doi:10.1016/S1470-2045(15)70137-3

    Article  CAS  PubMed  Google Scholar 

  2. Giacchetti S, Porcher R, Lehmann-Che J, Hamy AS, de Roquancourt A, Cuvier C, Cottu PH, Bertheau P, Albiter M, Bouhidel F, Coussy F, Extra JM, Marty M, de The H, Espie M (2014) Long-term survival of advanced triple-negative breast cancers with a dose-intense cyclophosphamide/anthracycline neoadjuvant regimen. Br J Cancer 110(6):1413–1419. doi:10.1038/bjc.2014.81

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Peto R, Davies C, Godwin J, Gray R, Pan HC, Clarke M, Cutter D, Darby S, McGale P, Taylor C, Wang YC, Bergh J, Di Leo A, Albain K, Swain S, Piccart M, Pritchard K (2012) Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet 379(9814):432–444. doi:10.1016/s0140-6736(11)61625-5

    Article  CAS  PubMed  Google Scholar 

  4. Fountzilas G, Kalofonos HP, Dafni U, Papadimitriou C, Bafaloukos D, Papakostas P, Kalogera-Fountzila A, Gogas H, Aravantinos G, Moulopoulos LA, Economopoulos T, Pectasides D, Maniadakis N, Siafaka V, Briasoulis E, Christodoulou C, Tsavdaridis D, Makrantonakis P, Razis E, Kosmidis P, Skarlos D, Dimopoulos MA (2004) Paclitaxel and epirubicin versus paclitaxel and carboplatin as first-line chemotherapy in patients with advanced breast cancer: a phase III study conducted by the Hellenic Cooperative Oncology Group. Ann Oncol 15(10):1517–1526. doi:10.1093/annonc/mdh395

    Article  CAS  PubMed  Google Scholar 

  5. Perez EA (2004) Carboplatin in combination therapy for metastatic breast cancer. Oncologist 9(5):518–527. doi:10.1634/theoncologist.9-5-518

    Article  CAS  PubMed  Google Scholar 

  6. von Minckwitz G, Schneeweiss A, Loibl S, Salat C, Denkert C, Rezai M, Blohmer JU, Jackisch C, Paepke S, Gerber B, Zahm DM, Kummel S, Eidtmann H, Klare P, Huober J, Costa S, Tesch H, Hanusch C, Hilfrich J, Khandan F, Fasching PA, Sinn BV, Engels K, Mehta K, Nekljudova V, Untch M (2014) Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer (GeparSixto; GBG 66): a randomised phase 2 trial. Lancet Oncol 15(7):747–756. doi:10.1016/s1470-2045(14)70160-3

    Article  Google Scholar 

  7. Coudert BP, Largillier R, Arnould L, Chollet P, Campone M, Coeffic D, Priou F, Gligorov J, Martin X, Trillet-Lenoir V, Weber B, Bleuse JP, Vasseur B, Serin D, Namer M (2007) Multicenter phase II trial of neoadjuvant therapy with trastuzumab, docetaxel, and carboplatin for human epidermal growth factor receptor-2-overexpressing stage II or III breast cancer: results of the GETN(A)-1 trial. J Clin Oncol 25(19):2678–2684. doi:10.1200/jco.2006.09.9994

    Article  CAS  PubMed  Google Scholar 

  8. Yu KD, Liu GY, Chen CM, Li JW, Wu J, Lu JS, Shen ZZ, Shao ZM (2013) Weekly paclitaxel/carboplatin/trastuzumab therapy improves pathologic complete remission in aggressive HER2-positive breast cancers, especially in luminal-B subtype, compared with a once-every-3-weeks schedule. Oncologist 18(5):511–517. doi:10.1634/theoncologist.2012-0057

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Sikov WM, Dizon DS, Strenger R, Legare RD, Theall KP, Graves TA, Gass JS, Kennedy TA, Fenton MA (2009) Frequent pathologic complete responses in aggressive stages II to III breast cancers with every-4-week carboplatin and weekly paclitaxel with or without trastuzumab: a Brown University Oncology Group Study. J Clin Oncol 27(28):4693–4700. doi:10.1200/jco.2008.21.4163

    Article  CAS  PubMed  Google Scholar 

  10. Chen XS, Nie XQ, Chen CM, Wu JY, Wu J, Lu JS, Shao ZM, Shen ZZ, Shen KW (2010) Weekly paclitaxel plus carboplatin is an effective nonanthracycline-containing regimen as neoadjuvant chemotherapy for breast cancer. Ann Oncol 21(5):961–967. doi:10.1093/annonc/mdq041

    Article  CAS  PubMed  Google Scholar 

  11. Norton L, Simon R (1986) The Norton-Simon hypothesis revisited. Cancer Treat Rep 70(1):163–169

    CAS  PubMed  Google Scholar 

  12. Norton L (2005) Conceptual and practical implications of breast tissue geometry: toward a more effective, less toxic therapy. Oncologist 10(6):370–381. doi:10.1634/theoncologist.10-6-370

    Article  CAS  PubMed  Google Scholar 

  13. Citron ML, Berry DA, Cirrincione C, Hudis C, Winer EP, Gradishar WJ, Davidson NE, Martino S, Livingston R, Ingle JN, Perez EA, Carpenter J, Hurd D, Holland JF, Smith BL, Sartor CI, Leung EH, Abrams J, Schilsky RL, Muss HB, Norton L (2003) Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol 21(8):1431–1439. doi:10.1200/jco.2003.09.081

    Article  CAS  PubMed  Google Scholar 

  14. Venturini M, Del Mastro L, Aitini E, Baldini E, Caroti C, Contu A, Testore F, Brema F, Pronzato P, Cavazzini G, Sertoli MR, Canavese G, Rosso R, Bruzzi P (2005) Dose-dense adjuvant chemotherapy in early breast cancer patients: results from a randomized trial. J Natl Cancer Inst 97(23):1724–1733. doi:10.1093/jnci/dji398

    Article  CAS  PubMed  Google Scholar 

  15. Untch M, Fasching PA, Konecny GE, von Koch F, Conrad U, Fett W, Kurzeder C, Luck HJ, Stickeler E, Urbaczyk H, Liedtke B, Salat C, Harbeck N, Muller V, Schmidt M, Hasmuller S, Lenhard M, Schuster T, Nekljudova V, Lebeau A, Loibl S, von Minckwitz G (2011) PREPARE trial: a randomized phase III trial comparing preoperative, dose-dense, dose-intensified chemotherapy with epirubicin, paclitaxel and CMF versus a standard-dosed epirubicin/cyclophosphamide followed by paclitaxel ± darbepoetin alfa in primary breast cancer–results at the time of surgery. Ann Oncol 22(9):1988–1998. doi:10.1093/annonc/mdq709

    Article  CAS  PubMed  Google Scholar 

  16. Jelliffe RW (1973) Letter: creatinine clearance: bedside estimate. Ann Intern Med 79(4):604–605

    Article  CAS  PubMed  Google Scholar 

  17. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5(6):649–655

    Article  CAS  PubMed  Google Scholar 

  18. Gluck S, de Snoo F, Peeters J, Stork-Sloots L, Somlo G (2013) Molecular subtyping of early-stage breast cancer identifies a group of patients who do not benefit from neoadjuvant chemotherapy. Breast Cancer Res Treat 139(3):759–767. doi:10.1007/s10549-013-2572-4

    Article  PubMed  Google Scholar 

  19. Bear HD, Anderson S, Smith RE, Geyer CE Jr, Mamounas EP, Fisher B, Brown AM, Robidoux A, Margolese R, Kahlenberg MS, Paik S, Soran A, Wickerham DL, Wolmark N (2006) Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: national Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 24(13):2019–2027. doi:10.1200/jco.2005.04.1665

    Article  CAS  PubMed  Google Scholar 

  20. Rastogi P, Anderson SJ, Bear HD, Geyer CE, Kahlenberg MS, Robidoux A, Margolese RG, Hoehn JL, Vogel VG, Dakhil SR, Tamkus D, King KM, Pajon ER, Wright MJ, Robert J, Paik S, Mamounas EP, Wolmark N (2008) Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol 26(5):778–785. doi:10.1200/jco.2007.15.0235

    Article  PubMed  Google Scholar 

  21. Buzdar AU, Singletary SE, Theriault RL, Booser DJ, Valero V, Ibrahim N, Smith TL, Asmar L, Frye D, Manuel N, Kau SW, McNeese M, Strom E, Hunt K, Ames F, Hortobagyi GN (1999) Prospective evaluation of paclitaxel versus combination chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide as neoadjuvant therapy in patients with operable breast cancer. J Clin Oncol 17(11):3412–3417

    CAS  PubMed  Google Scholar 

  22. Gradishar WJ, Wedam SB, Jahanzeb M, Erban J, Limentani SA, Tsai KT, Olsen SR, Swain SM (2005) Neoadjuvant docetaxel followed by adjuvant doxorubicin and cyclophosphamide in patients with stage III breast cancer. Ann Oncol 16(8):1297–1304. doi:10.1093/annonc/mdi254

    Article  CAS  PubMed  Google Scholar 

  23. Green MC, Buzdar AU, Smith T, Ibrahim NK, Valero V, Rosales MF, Cristofanilli M, Booser DJ, Pusztai L, Rivera E, Theriault RL, Carter C, Frye D, Hunt KK, Symmans WF, Strom EA, Sahin AA, Sikov W, Hortobagyi GN (2005) Weekly paclitaxel improves pathologic complete remission in operable breast cancer when compared with paclitaxel once every 3 weeks. J Clin Oncol 23(25):5983–5992. doi:10.1200/jco.2005.06.232

    Article  CAS  PubMed  Google Scholar 

  24. Buzdar AU, Ibrahim NK, Francis D, Booser DJ, Thomas ES, Theriault RL, Pusztai L, Green MC, Arun BK, Giordano SH, Cristofanilli M, Frye DK, Smith TL, Hunt KK, Singletary SE, Sahin AA, Ewer MS, Buchholz TA, Berry D, Hortobagyi GN (2005) Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol 23(16):3676–3685. doi:10.1200/jco.2005.07.032

    Article  CAS  PubMed  Google Scholar 

  25. Gianni L, Eiermann W, Semiglazov V, Manikhas A, Lluch A, Tjulandin S, Zambetti M, Vazquez F, Byakhow M, Lichinitser M, Climent MA, Ciruelos E, Ojeda B, Mansutti M, Bozhok A, Baronio R, Feyereislova A, Barton C, Valagussa P, Baselga J (2010) Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet 375(9712):377–384. doi:10.1016/s0140-6736(09)61964-4

    Article  CAS  PubMed  Google Scholar 

  26. Gianni L, Eiermann W, Semiglazov V, Lluch A, Tjulandin S, Zambetti M, Moliterni A, Vazquez F, Byakhov MJ, Lichinitser M, Climent MA, Ciruelos E, Ojeda B, Mansutti M, Bozhok A, Magazzu D, Heinzmann D, Steinseifer J, Valagussa P, Baselga J (2014) Neoadjuvant and adjuvant trastuzumab in patients with HER2-positive locally advanced breast cancer (NOAH): follow-up of a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet Oncol 15(6):640–647. doi:10.1016/s1470-2045(14)70080-4

    Article  CAS  PubMed  Google Scholar 

  27. Untch M, Rezai M, Loibl S, Fasching PA, Huober J, Tesch H, Bauerfeind I, Hilfrich J, Eidtmann H, Gerber B, Hanusch C, Kuhn T, du Bois A, Blohmer JU, Thomssen C, Dan Costa S, Jackisch C, Kaufmann M, Mehta K, von Minckwitz G (2010) Neoadjuvant treatment with trastuzumab in HER2-positive breast cancer: results from the GeparQuattro study. J Clin Oncol 28(12):2024–2031. doi:10.1200/jco.2009.23.8451

    Article  CAS  PubMed  Google Scholar 

  28. Lazaridis G, Pentheroudakis G, Pavlidis N (2008) Integrating trastuzumab in the neoadjuvant treatment of primary breast cancer: accumulating evidence of efficacy, synergy and safety. Crit Rev Oncol Hematol 66(1):31–41. doi:10.1016/j.critrevonc.2007.07.002

    Article  PubMed  Google Scholar 

  29. Katsumata N, Yasuda M, Takahashi F, Isonishi S, Jobo T, Aoki D, Tsuda H, Sugiyama T, Kodama S, Kimura E, Ochiai K, Noda K (2009) Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial. Lancet 374(9698):1331–1338. doi:10.1016/s0140-6736(09)61157-0

    Article  CAS  PubMed  Google Scholar 

  30. Pritchard KI, Messersmith H, Elavathil L, Trudeau M, O’Malley F, Dhesy-Thind B (2008) HER-2 and topoisomerase II as predictors of response to chemotherapy. J Clin Oncol 26(5):736–744. doi:10.1200/jco.2007.15.4716

    Article  CAS  PubMed  Google Scholar 

  31. Bear HD, Anderson S, Brown A, Smith R, Mamounas EP, Fisher B, Margolese R, Theoret H, Soran A, Wickerham DL, Wolmark N (2003) The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 21(22):4165–4174. doi:10.1200/jco.2003.12.005

    Article  CAS  PubMed  Google Scholar 

  32. Rouzier R, Perou CM, Symmans WF, Ibrahim N, Cristofanilli M, Anderson K, Hess KR, Stec J, Ayers M, Wagner P, Morandi P, Fan C, Rabiul I, Ross JS, Hortobagyi GN, Pusztai L (2005) Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res 11(16):5678–5685. doi:10.1158/1078-0432.ccr-04-2421

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank all of the patients for their participation and all of their physicians for their hard work. The abstract was selected for presentation as part of a general poster session at the 50th Annual Meeting of the American Society of Clinical Oncology (ASCO:5.30–6.03, 2014) in Chicago.

Funding

This study is registered with ClinicalTrials.gov (NCT0205986). This study was supported by the Science and Technology Planning Project of Guangdong Province, China (2012B031800405). The funding source had no role in the study.

Author information

Author notes

    Authors and Affiliations

    1. Department of Breast Cancer, Cancer Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China

      T. Zhu, Y. F. Zhang, Y. H. Liu, F. P. Xu, J. Zu, G. C. Zhang, X. R. Li, N. Liao & K. Wang

    2. Department of Radiology, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, 510080, China

      C. L. Liu

    Authors
    1. T. Zhu
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. C. L. Liu
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Y. F. Zhang
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Y. H. Liu
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. F. P. Xu
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. J. Zu
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. G. C. Zhang
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. X. R. Li
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. N. Liao
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. K. Wang
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to K. Wang.

    Ethics declarations

    Conflict of interest

    We declare that none of the authors have any conflicts of interest.

    Additional information

    T. Zhu and C. L. Liu have contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Zhu, T., Liu, C.L., Zhang, Y.F. et al. A phase II trial of dose-dense (biweekly) paclitaxel plus carboplatin as neoadjuvant chemotherapy for operable breast cancer. Breast Cancer Res Treat 156, 117–124 (2016). https://doi.org/10.1007/s10549-016-3735-x

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10549-016-3735-x

    Keywords

    Search

    Navigation