Adding fasting-mimicking diet to first-line carboplatin-based chemotherapy is associated with better overall survival in advanced triple-negative breast cancer patients: A subanalysis of the NCT03340935 trial

Severe calorie restriction, in the form of cyclic fasting or fasting-mimicking diets (FMDs), boosts the antitumor activity of cytotoxic chemotherapy in mouse models of triple-negative breast cancer (TNBC). This effect is mostly mediated by fasting/FMD-induced reduction of plasma glucose concentration and by a boost in antitumor immunity. However, clinical evidence that cyclic FMD may impact on the outcomes of advanced TNBC (aTNBC) patients is lacking. We compared the overall survival (OS) of 14 aTNBC patients receiving first-line carboplatin-gemcitabine plus cyclic FMD in the context of the NCT03340935 trial with the OS of 76 consecutive aTNBC patients treated with carboplatin-based chemotherapy alone at Fondazione IRCCS Istituto Nazionale dei Tumori. Multivariable Cox regression models were used to adjust the prognostic impact of FMD for other prognostic variables. Patients undergoing cyclic FMD in combination with carboplatin-gemcitabine had better OS when compared to patients receiving chemotherapy alone (median OS 30.3 months, 95% CI 18-NR, vs 17.2 months, 95% CI 15.3-25.1, log-rank P value .041). Multivariable analysis confirmed an association between FMD use and better OS (HR: 0.40; 95% CI: 0.19-0.86; P = .019) also after propensity score-based matching according to patient ECOG PS and the presence of de novo metastatic disease (HR: 0.41; 95% CI: 0.21-0.83; P = .013). Cyclic FMD in combination with first-line chemotherapy may improve clinical outcomes in aTNBC patients. Our study paves the way for conducting phase II trials to investigate if cyclic FMD can increase the antitumor activity/efficacy of chemotherapy or chemoimmunotherapy in patients with early-stage TNBC or aTNBC.

Comparison of apatinib and capecitabine (Xeloda) with capecitabine (Xeloda) in advanced triple-negative breast cancer as third-line therapy: A retrospective study

The treatment of advanced triple-negative breast cancer, which failed in first-line or second-line therapy, is a significant challenge. We conducted this retrospective study to explore the efficacy and safety of apatinib and capecitabine as the third-line treatment for advanced triple-negative breast cancer.This retrospective study involved 44 advanced triple-negative breast cancer patients who failed in first-line or second-line therapy in Tangshan People's Hospital from January 2016 to February 2017. Twenty-two patients received apatinib and capecitabine, while 22 patients were treated with capecitabine monotherapy as third-line therapy. The progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events were compared between 2 groups.The apatinib and capecitabine group exhibited a higher PFS than capecitabine group (P = .001). Meanwhile, ORR and DCR in apatinib and capecitabine group were better than in capecitabine group (P = .042; .016). The 2 groups showed no significant difference in adverse events except degree I-II bleeding (P = .021). Both the apatinib and capecitabine and the capecitabine regimens revealed good tolerability.The apatinib and capecitabine regimen can achieve a better efficacy and similar serious adverse events compared with capecitabine regimen as the third-line treatment for advanced triple-negative breast cancer.

Clinical efficacy of administering oxaliplatin combined with S-1 in the treatment of advanced triple-negative breast cancer

Triple-negative breast cancer (TNBC) is not amenable to current targeted therapies and carries a poor prognosis; however, a specific systemic regimen cannot yet be recommended. The optimal duration of oxaliplatin (OXA) and S-1 combinatorial chemotherapy in patients with advanced breast cancer is not currently known and is likely to be patient-specific based on efficacy and toxicity. In the present study, 52 patients with advanced TNBC received OXA and S-1 chemotherapy. The efficacy and toxicity were observed. The results showed that the median number of regimens was 4 (range 2-6). The therapeutic efficacy was evaluated in all patients. The complete response, partial response, overall response and disease control rates were 3.8, 30.8, 34.6 and 69.2%, respectively. Four patients were lost to follow-up, and the median follow-up time was 13.7 months. The median progression-free survival time was 6.7 months [95% confidence interval (CI), 4.5-9.0] and the median overall survival (OS) time was 13.3 months (95% CI, 9.1-17.5). From the subgroup analysis, it was found that the median OS time of patients with stage IV disease and ≥2 metastases was significantly shorter than that of patients with stage IIIC disease and only 1 metastasis [11.3 vs. 22.7 months, P=0.010 (stage IV vs. stage IIC); 11.3 vs. 15.7 months, P=0.048 (≥2 vs. 1 metastasis)]. The main grade 3/4 toxic effects were neutropenia (11.5%), nausea (7.7%) and nerve toxicity (3.8%). The other toxic effects were mainly of grades 1-2 and included diarrhea, liver dysfunction, stomatitis, anemia and hand-foot syndrome. In conclusion, OXA combined with S-1 is an effective and tolerable regimen for the treatment of patients with advanced TNBC.