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Evidence summaries

Platinum Containing Regimens for Triple-Negative Breast Cancer

Platinum-containing chemotherapy regimens compared with regimens not containing platinum are effective in early triple-negative (oestrogen and progesterone receptors and human epidermal receptor 2 [HER2]) breast cancer and appear to be effective for metastatic triple-negative breast cancer, but at the cost of more adverse effects. In breast cancer unselective for these three receptors, they are not effective. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 24 trials involving a total of 4 418 women. Triple-negative breast cancer (TNBC) is characterised by a lack of expression of oestrogen and progesterone receptors and human epidermal receptor 2 (HER2) and is assosiated with a shorter survival and higher likelihood of recurrence. In metatastatic TNBC platinum-containg regimens increased overall and progression-free survival compared with no platinum-containing regimens. In women with no TNBC, there was no response: the hazard ratio (HR) for overall survival was 1.01 (95% CI 0.92-1.12) and time to progression (overall HR 0.92; 95% CI 0.84-1.01). Adverse effects like leukopenia, hair loss, nausea and vomiting and anaemia were statistically significantly more common with platinum-containing regimens.

Another Cochrane review [Abstract] 3 included 13 trials involving a total of 1 349 women. In metatastatic triple-negative breast cancer platinum-containg regimens increased overall and progression-free survival compared with no platinum-containing regimens (table T1).

Platinum compared to non-platinum chemotherapy regimens for metastatic triple-negative breast cancer

OutcomeHazard ratio (95% CI)Risk with control - non-platinum chemotherapyRisk with intervention - Platinum chemotherapy (95% CI)No of participants (studies) Quality of evidence
Overall survival: 1-year risk of deathHR 0.85 (0.73 to 1.00)510 per 1000455 per 1000 (406 to 510)958 (6) Moderate
Overall survival: 2-year risk of death711 per 1000652 per 1000 (596 to 711)
Progression -free survival: 1-year risk of deathHR 0.77 (0.68 to 0.88)936 per 1000880 per 1000 (846 to 911)1077 (8) Very low
Progression -free survival: 2-year risk of death970 per 1000933 per 1000 (908 to 954)
Objective tumour response rateRR 1.40(1.22 to 1.59)368 per 1000515 per 1000 (449 to 585)1205 (10) Low

Another Cochrane review [Abstract] 2 included 20 trials. In early triple-negative breast cancer platinum-containg regimens (in neoadjuvant or adjuvant therapy) increased overall and progression-free survival compared with no platinum-containing regimens (table T2).

Platinum compared to non-platinum chemotherapy regimens for early triple-negative breast cancer

OutcomeHazard ratio (95% CI)Risk with control - non-platinum chemotherapyRisk with intervention - Platinum chemotherapy (95% CI)No of participants (studies) Quality of evidence
Neoadjuvant therapy
Disease free survival at 5 years (risk of recurrence) follow-up range 3 to 7.9 yearsHR 0.63(0.53 to 0.75)301 per 1000202 per 1000(173 to 235)1966(8) High
Overall survival at 5 years;follow-up range 1.7 to 7.9 yearsHR 0.69(0.55 to 0.86)190 per 1000135 per 1000(110 to 166)1973(8) High
Adjuvant therapy
Disease free survival at 5 years;follow-up range 4.3 to 8 yearsHR 0.69(0.54 to 0.88)169 per 1000120 per 1000(95 to 150)1256(4) High
Overall survival at 5 years;follow-up range 4.3 to 8 yearsHR 0.70(0.50 to 0.96)81 per 100057 per 1000(41 to 78)1256(4) High

References

  • Egger SJ, Willson ML, Morgan J et al. Platinum-containing regimens for metastatic breast cancer. Cochrane Database Syst Rev 2017;(6):CD003374. [PubMed]
  • Egger SJ, Chan MMK, Luo Q et al. Platinum-containing regimens for triple-negative metastatic breast cancer. Cochrane Database Syst Rev 2020;(10):CD013750. [PubMed]
  • Mason SR, Willson ML, Egger SJ, ym. Platinum-based chemotherapy for early triple-negative breast cancer. Cochrane Database Syst Rev 2023;9(9):CD014805[PubMed]

Primary/Secondary Keywords