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| |  IBCC: Platinum Compounds May Become Adjuvant Therapy for Breast Cancer By Alison Palkhivala BANFF, AB -- August 7, 2003 -- Early provocative data is demonstrating that platinum compounds, particularly in combination with other agents, have an important role to play in the treatment of breast cancer. These agents may soon be used routinely in the adjuvant setting for this condition, according to researchers speaking here on August 2nd at the Second Annual Future of Breast Cancer: An International Breast Cancer Congress. Until recently, platinum compounds did not play a major role in the treatment of breast cancer. New research indicates, however, that proper use of platinum compounds can lead to exceptional response rates with reasonable toxicity levels. Joyce O'Shaughnessy, MD, co-director of breast cancer research, Baylor Charles A. Sammons Cancer Center, Dallas, Texas, United States, noted that, since 2000, there has been an increased interest in the use of these compounds for this condition, with several phase II clinical trials demonstrating important benefits. Among key factors in this evolution was the development of 5HT3 receptor antagonists, which help control adverse events, and learning to dose carboplatin by AUC instead of mg/m2. As of yet, however, there is limited phase III data on the role of platinum compounds in breast cancer. Recent research demonstrated that platinum compounds work synergistically with other agents commonly used in breast cancer, including the taxanes and trastuzumab. For instance, in 2000 Perez et al. reported a remarkable 62% response rate, 16% complete response, and 7-month median time to progression in women with metastatic breast carcinoma using a first-line regimen of paclitaxel plus carboplatin. Neutropenia, which tended to be modest, was the most significant side effect (Cancer 2000;88:124-131). Robert et al., from the US Oncology Network, examined various combinations of trastuzumab, paclitaxel and carboplatin, revealing that this triple therapy is very active in human epidermal growth factor receptor 2- (HER 2) positive breast cancer (San Antonio Breast Cancer Symposium, 2002, Abstract 35 "Phase III comparative study of trastuzumab and paclitaxel with and without carboplatin in patients with HER-2/neu positive advanced breast cancer"). Recent data has also shed light on the best way to dose platinum compounds. In the Perez study, carboplatin was dosed every 3 weeks. However, Loesch et al, also with the US Oncology Network, obtained a similar response rate and improved tolerability when they dosed platinum compounds for 3 weeks on, 1 week off (J Clin Oncol 2002. Sep 15;20(18):3857-64). Another hopeful combination for breast cancer appears to be platinum compounds combined with gemcitabine. This combination depends on DNA repair being intact, which may mean it has less cross-resistance. Several early studies demonstrated the efficacy of this combination in pre-treated patients, and confirmatory evidence should be forthcoming, Dr. O'Shaughnessy said. "In my own practice, gemcitabine/carboplatin is my 'go to' regimen for anthracycline-, taxane- and capecitabine-pre-treated patients," she explained. "I find it considerably non-cross-resistant and very well tolerated. But we have to wait for phase II data on this." Dr. O' Shaughnessy predicted that platinum compounds will soon be moved to the adjuvant setting for the treatment of breast cancer.
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