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Role of Platinum in Early-Stage Triple-Negative Breast Cancer
Alyssa La Belle1, Jude Khatib2, William P Schiemann3,3
1Case Comprehensive Cancer Center, Case Western Reserve University, Wolstein Research Building, 2103 Cornell Road, Cleveland, OH, 44106, USA.
Opinion Statement:
Triple-negative breast cancer (TNBC) is both a clinically and genomically heterogeneous disease, with distinct molecular subtypes; however, most epidemiologic and clinical studies to date have defined it under a "one disease" umbrella. This is an important point, since one therapeutic approach for all TNBCs is unlikely to be successful given the underlying biological diversity. In this review, we explore the role of platinums in the treatment of TNBC, as well as the potential for biomarkers to predict patient response to these agents. The results of neoadjuvant TNBC trials, with addition of platinum to anthracycline/taxane-based chemotherapies, have been very encouraging given increases in pathologic complete response (pCR) rates. However, we do not have any evidence yet that these agents would lead to improvement in disease-free and overall survival. Moreover, addition of platinums increases toxicity and can compromise current standard chemotherapy doses, which further impedes their use in all TNBC patients. Therefore, the addition of platinums to standard chemotherapy should be used with caution and in discussion with patients after a careful assessment of risks and benefits. Clinical trials addressing the role of platinums in TNBC further remain of significant value.
Insights
Platinum-based chemotherapy shows promise for triple-negative breast cancer (TNBC) by increasing pathologic complete response rates. However, survival benefits are unproven, and increased toxicity necessitates cautious use and further clinical trials.
Area of Science:
- Oncology
- Genomics
- Pharmacology
Background:
- Triple-negative breast cancer (TNBC) is a heterogeneous disease with diverse molecular subtypes.
- Current treatment strategies often overlook this heterogeneity, potentially limiting therapeutic success.
- Platinum agents are being investigated for their role in TNBC treatment.
Purpose of the Study:
- To review the efficacy of platinum agents in TNBC treatment.
- To explore the potential of biomarkers in predicting patient response to platinum-based therapies.
- To discuss the benefits and risks associated with incorporating platinum agents into TNBC chemotherapy regimens.
Main Methods:
- Review of existing neoadjuvant TNBC clinical trial data.
- Analysis of pathologic complete response (pCR) rates with platinum addition.
- Assessment of platinum agent toxicity and impact on standard chemotherapy doses.
Main Results:
- Addition of platinum to anthracycline/taxane-based chemotherapy significantly increased pCR rates in neoadjuvant TNBC trials.
- No current evidence demonstrates improved disease-free or overall survival with platinum-based regimens.
- Platinum agents increase toxicity and may necessitate reduced standard chemotherapy doses.
Conclusions:
- Platinum-based chemotherapy offers encouraging pCR rates for TNBC but lacks proven survival benefits.
- The increased toxicity and potential compromise of standard doses warrant cautious use and patient-physician discussion.
- Further clinical trials are essential to clarify the role and optimize the use of platinum agents in TNBC management.
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