Preoperative dose-dense docetaxel and cyclophosphamide alternating with epirubicin and cisplatin(ddDCEP): an effective, novel way of incorporating platinum in the treatment of early TNBC

Abstract

Purpose Carboplatin-containing treatment regimens in early TNBC have shown improved pCR(pathological complete response) and better EFS(event-free survival) but at the expense of increased toxicity, often leading to compromised delivery of planned treatment. We aimed to evaluate a novel alternating regimen to incorporate platinum in early TNBC. Methods We analyzed the data of women with early TNBC who were treated with four cycles each of docetaxel(D;75 mg/m2) and cyclophosphamide(C;600 mg/m2) alternating with cisplatin(P;60 mg/m2) and epirubicin(E;90 mg/m2) (ddDCEP) given every two weeks over a duration of 16 weeks. Pathological complete response was the primary endpoint assessed, along with treatment delivery, adverse events, and survival. Results A total of 116 women with stage I-III TNBC received neoadjuvant ddDCEP. Pathological complete response(pCR) defined as no residual invasive cancer in both breast(T0/Tis) and axilla(N0), was observed in 55.2% of all evaluable patients. The proportion of pCR in stage I/II disease was 62.2%, and stage III was 49.5%. 37.9% of patients developed grade 3 anaemia. Grade 3/4 neutropenia occurred in 16.3%, and febrile neutropenia in 4.3% of patients. 86% of patients completed all 8 cycles of chemotherapy, and 98% at least 6 out of 8 cycles. 12% of patients required a dose reduction of taxane, 13% for epirubicin, and 19% for platinum. The proportion of patients requiring dose reduction and the average total dose reduction was significantly higher in the pCR compared to the no pCR group for cisplatin and epirubicin. At 2 years of median follow-up, the recurrence-free survival was 91.2%, and overall survival was 97%. Conclusion In non-metastatic TNBC, treatment with ddDCEP as neoadjuvant therapy resulted in a high pCR(55.2%) proportion allowing good delivery of all planned therapy with manageable toxicity.