Nonanthracycline containing docetaxel-based combinations in metastatic breast cancer

Many active nonanthracycline-containing regimens are emerging from clinical trials and may offer the option of treating metastatic breast cancer without resorting to doxorubicin or analogues. When used first-line in metastatic breast cancer, both cisplatin and carboplatin are active agents and hence candidates for combination therapy. In a dose-finding study in patients with no prior chemotherapy for metastatic disease, docetaxel administered together with cisplatin produced a promising response rate (RR) of 60% (73% in patients without prior adjuvant chemotherapy). The combination is feasible, although adequate hydration and antiemetic medication must be given. There is also an early indication that it may be possible to dramatically cytoreduce disease in patients with locally advanced breast cancer who are treated with docetaxel plus cisplatin. Given its lower toxicity, carboplatin may also have a role in combination with the taxanes. Of the nonplatinum agents, vinorelbine appears to hold promise; its combination with docetaxel produced an RR of 59% in a group of anthracycline-pretreated patients with progressive disease. Forty-two percent of the patients studied also had prior exposure to a taxane. Weekly gemcitabine plus monthly docetaxel is feasible and active, as is the combination of docetaxel q 3 weeks with daily oral capecitabine.