Taxol and Carboplatin for Neoadjuvant Therapy

Docetaxel and carboplatin is a well established chemotherapy regimen for breast cancer. The advantage of this combination is that it does not contain an anthracycline, which can negatively affect heart function. Two independent phase II studies have shown that the combination of carboplatin and docetaxel (Taxotere®; Aventis Pharmaceuticals, Inc.; Bridgewater, NJ) is active in the first-line treatment of metastatic breast cancer.

A recent review concluded: “In several phase II studies, combination carboplatin and paclitaxel (Taxol®; Bristol-Myers Squibb) therapy was active and reasonably well tolerated in the first-line treatment of metastatic breast cancer, producing objective response rates of 53%–62%—substantially higher rates than those seen in other phase II trials of either drug alone. Similar phase II data for carboplatin with docetaxel (Taxotere®; Aventis; Bridgewater, NJ) have been reported in other studies, and recent phase III data suggest that adding carboplatin to a paclitaxel/trastuzumab regimen produces superior efficacy than paclitaxel/trastuzumab alone for patients with HER2+ metastatic disease. Drug scheduling plays an important role in the therapeutic ratio of this combination treatment.”

There is less information on using this regimen for neoadjuvant therapy, treating cancer to shrink it before surgery. There are Phase II studies that suggest the weekly schedule rather once in three weeks schedule for the neoadjuvant settings. NCCN does not specifically list this regimen for neaodjuvant use. However, on p. BINV-12 NCCS says: “in general, dose chemotherapy regimens recommended in the adjuvant setting may be considered in the preoperative setting”. Adjuvant therapy is administered after the primary treatment, breast cancer surgery. Nevertheless, NCCN does not specifically recommend this regimen in the adjuvant setting either.

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