How Researchers Wiped Out Triple-Negative Breast Cancer

Triple negative breast cancer responded well to combination therapy

(RxWiki News) Triple-negative breast cancer is a fast-growing form of the disease that tends to return (recur). But a fresh therapeutic approach was found to be capable of eliminating the disease altogether.New research demonstrated that a combination therapy involving standard chemotherapy, Paraplatin (carboplatin) and Avastin (bevacizumab) was effective in wiping out triple-negative breast cancer before surgery.

Women whose cancer disappeared are expected to have a much lower risk of recurrence than patients whose cancer did not respond to the therapy given before surgery (neoadjuvant).

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William M. Sikov, MD, FACP, associate professor of medicine at the Warren Alpert Medical School of Brown University in Providence, RI, was the lead investigator of this phase ll clinical trial that involved 443 women with triple-negative breast cancer.

It’s called triple-negative breast cancer because the cells don’t have the three receptors that most breast cancers do. As a result, this type of breast cancer can be tough to treat because there are no targets for medications to attack and kill. About 20 percent of breast cancers are triple-negative.

The participants in this clinical trial all had operable stage II or stage III triple-negative breast cancer. The women were randomly assigned to one of four groups: 1) standard neoadjuvant chemotherapy only, 2) standard neoadjuvant chemotherapy plus carboplatin, 3) standard neoadjuvant chemotherapy plus bevacizumab, or 4) standard neoadjuvant chemotherapy plus carboplatin and bevacizumab.

Standard neoadjuvant chemotherapy is a combination of paclitaxel (brand names Abraxane, Onxol, Taxol), doxorubicin (Adriamycin) and cyclophosphamide (Cytoxin and Neosar).

Surgery was performed four to eight weeks following the completion of the chemotherapy.

The researchers discovered pathologic complete responses (PCR), meaning the cancer had been eliminated in some of the women from all of the groups.

  • Chemotherapy only: 42 percent PCR in the breast, 39 percent PCR in breast and lymph nodes
  • Chemotherapy plus carboplatin: 52 percent PCR in breast, 49 percent PCR in breast and lymph nodes
  • Chemotherapy plus bevacizumab: 50 percent breast PCR; 43 percent breast and lymph node PCR
  • Chemotherapy plus carboplatin and bevacizumab: 67 percent PCR in breast; 60 percent PCR in breast and lymph node

Patients treated with carboplatin and bevacizumab had more difficulties with blood clots than those who didn’t receive these medications.

Patients who received bevacizumab also had more difficulties with bleeding and infections than did women who didn’t receive this medication.

The researchers plan to follow study participants for 10 years from the time of their surgery to evaluate long-term outcomes.

“Our findings suggest that carboplatin could be used either in addition to or instead of some of the drugs in the standard chemotherapy regimen for women with triple-negative breast cancer,” the study's senior author, Eric Winer, MD, chief of the division of Women’s Cancers in the Susan F. Smith Center for Women’s Cancers at Dana-Farber Cancer Institute, said in a statement.

Nationally known breast cancer expert Adam M. Brufsky, MD, PhD, professor of medicine at the University of Pittsburgh School of Medicine, told dailyRx News, “The data on the addition of carboplatin and bevacizumab to standard neoadjuvant chemotherapy for [triple-negative breast cancer] are interesting, and in the case of carboplatin statistically significant in terms of improving the pathologic complete response rate in the lymph nodes and in the breast by about 10 percent. The toxicity is clearly greater, but manageable. Whether this translates to a better outcome in terms of disease-free survival in [triple-negative breast cancer] remains unclear at this point."

Results from this trial were presented at the 2013 San Antonio Breast Cancer Symposium.

This study was funded by the National Institutes of Health, Genentech, the maker carboplatin and bevacizumab, and the Breast Cancer Research Foundation. Two of the researchers reported industry financial ties; one of these authors has received research support from Genentech.

All research is considered preliminary before being published in a peer-reviewed journal.

Review Date: 
December 12, 2013