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

Purpose The addition of carboplatin has improved pathological complete response (PCR) and event-free survival (EFS) and is becoming a new standard of care for early triple-negative breast cancer (TNBC). However, this comes at the expense of increased toxicity. Here, we aimed to evaluate a novel cisplatin-based chemotherapy regimen for early TNBC. Methods Women with early TNBC who were administered neoadjuvant chemotherapy consisting of four cycles of docetaxel and cyclophosphamide alternated with cisplatin and epirubicin (ddDCEP) given every two weeks over a 16-week period were analyzed in this retrospective real-world study, driven by physician preference. The major outcomes assessed were PCR and EFS. Other outcomes included overall survival, treatment delivery, and adverse events. Results From January 2017 to January 2020, 116 women with stage I-III TNBC received neoadjuvant ddDCEP. PCR (ypT0/TisN0) was observed in 55.2% of evaluable patients. The PCR in stage I/II disease was 62.2%, and stage III was 49.5%. 37.9% of patients developed grade 3 anemia during treatment. Incidence of grade 3/4 neutropenia was 16.3%, and febrile neutropenia was 4.3%. 86% of patients completed all 8 cycles of planned chemotherapy, and 98% at least 6 out of 8 cycles. 12% patients required dose reduction of taxane and 19% for cisplatin. At 30 months of median follow-up, the EFS was 91.2%, and overall survival was 97%. Cost analysis showed this regimen was more cost-effective than carboplatin-based regimens. Conclusion Treatment with ddDCEP led to pCR in a significant proportion of patients, with high completion rates and lower toxicity, particularly neutropenia. These findings suggest that ddDCEP may be a promising, cost-effective treatment option for early TNBC.