A randomized phase 3 trial of Gemcitabine or Nab-paclitaxel combined with cisPlatin as first-line treatment in patients with metastatic triple-negative breast cancer

Platinum is recommended in combination with gemcitabine in the treatment of metastatic triple-negative breast cancer (mTNBC). We conduct a randomized phase 3, controlled, openlabel trial to compare nab-paclitaxel/cisplatin (AP) with gemcitabine/cisplatin (GP) in mTNBC patients (ClinicalTrials.gov NCT02546934). 254 patients with untreated mTNBC randomly receive AP (nab-paclitaxel 125 mg/m(2) on day 1, 8 and cisplatin 75 mg/m(2) on day 1) or GP (gemcitabine 1250 mg/m(2) on day 1, 8 and cisplatin 75 mg/m(2) on day 1) intravenously every 3 weeks until progression disease, intolerable toxicity or withdrawal of consent. The primary endpoint is progression-free survival (PFS); secondary endpoints are objective response rate (ORR), safety and overall survival (OS). The trial has met pre-specified endpoints. The median PFS is 9.8 months with AP as compared to 7.4 months with GP (stratified HR, 0.67; 95% CI, 0.50-0.88; P = 0.004). AP significantly increases ORR (81.1% vs. 56.3%, P < 0.001) and prolongs OS (stratified HR, 0.62; 95% CI, 0.44-0.90; P = 0.010) to GP. Of grade 3 or 4 adverse events, a significantly higher incidence of neuropathy in AP and thrombocytopenia in GP is noted. These findings warrant further assessment of adding novel agents to the nab-paclitaxel/platinum backbone due to its high potency for patients with mTNBC.

Automated summary

Platinum in combination with gemcitabine is recommended for the treatment of metastatic triple-negative breast cancer. In a randomized controlled trial, nab-paclitaxel/cisplatin was compared with gemcitabine/cisplatin in mTNBC patients. The study found that nab-paclitaxel/cisplatin significantly improved progression-free survival, objective response rate, and overall survival compared to gemcitabine/cisplatin. However, there were higher incidences of neuropathy in the nab-paclitaxel/cisplatin group and thrombocytopenia in the gemcitabine/cisplatin group.