Is continuing paclitaxel (Taxol) an option for a patient with triple negative breast cancer who has progressed after 6 months of treatment?

From the Guidelines

Continuing paclitaxel alone is not recommended for a patient with triple negative breast cancer who has progressed after 6 months of treatment. According to the NCCN guidelines 1, disease progression during or after chemotherapy indicates resistance to the current regimen, and continuing the same treatment is unlikely to provide additional benefit. Instead, switching to a different chemotherapy agent or combination would be more appropriate. Options might include platinum agents like carboplatin or cisplatin, gemcitabine, capecitabine, eribulin, or vinorelbine. For patients who have received prior anthracyclines, agents like eribulin may be considered. The choice of subsequent therapy should be based on the patient's prior treatments, performance status, comorbidities, and toxicity profile.

Some key points to consider when choosing a subsequent therapy include:

• The patient's prior treatments and response to those treatments
• The patient's performance status and comorbidities
• The toxicity profile of the potential subsequent therapies
• The potential benefits and risks of each subsequent therapy option

The ESMO clinical practice guidelines 1 also support the use of various chemotherapy agents and combinations for the treatment of metastatic breast cancer, including triple negative breast cancer. However, the guidelines emphasize that there is no standard approach for patients requiring second- or further-line chemotherapy treatment, and that the duration of each regimen and number of regimens should be tailored to each individual patient.

In terms of specific treatment options, the NCCN guidelines 1 suggest that combination chemotherapy regimens containing a platinum agent or a taxane may be efficacious in patients with metastatic triple-negative breast cancer. The guidelines also note that paclitaxel/carboplatin is an effective therapeutic option in this setting, with a median PFS of 8.3 months and a median OS of 16.8 months in one study.

Overall, the decision to continue or change therapy should be based on a thorough discussion with the patient about their goals of care, clinical trial options, and potential benefits versus risks of subsequent lines of therapy. Switching to a different chemotherapy agent or combination is likely to be more beneficial than continuing paclitaxel alone, and the choice of subsequent therapy should be individualized based on the patient's unique circumstances.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment Options for Triple Negative Breast Cancer

• The treatment options for triple negative breast cancer are limited, and the disease has a poor prognosis 2, 3.
• Chemotherapies such as taxanes and anthracyclines have been the traditional treatment regimens for TNBC patients 3.
• Paclitaxel, docetaxel, doxorubicin, and epirubicin have been longstanding, Food and Drug Administration (FDA)-approved therapies against TNBC 3.

Continuing Paclitaxel After Progression

• There is no direct evidence to support continuing paclitaxel after progression in patients with triple negative breast cancer 2, 4, 3, 5, 6.
• However, the ATRACTIB trial showed that the combination of atezolizumab, paclitaxel, and bevacizumab demonstrated significant antitumor activity as first-line therapy for aTNBC patients 4.
• Sacituzumab govitecan has been identified as a preferred second-line treatment option for patients with metastatic triple-negative breast cancer, supported by clinical evidence and consensus across international clinical guidelines 2, 5.

Alternative Treatment Options

• Other chemotherapies with lower European Society for Medical Oncology-Magnitude of Clinical Benefit Scale scores may continue to be useful in highly selected patients 2.
• Olaparib and talazoparib are of use in patients with human epidermal growth factor receptor 2-negative metastatic breast cancer and germline BRCA1/2 mutations 2.
• Exploratory data for fam-trastuzumab-deruxtecan suggest a survival benefit in human epidermal growth factor receptor 2-low, hormone-receptor-negative patients, but further solid evidence is required 2.