Triple Negative Breast Cancer Trial (TNT)

• Time to progression: this will be defined according to RECIST criteria and will be measured from the start of treatment until the confirmation of progression
• Progression free survival: this will be defined according to RECIST criteria and will be measured from the start of treatment until the confirmation of progression or death.
• Time to treatment failure: this will be defined as time from randomisation to discontinuation of protocol treatment for any reason, or progression of disease as defined by RECIST
• Overall survival: this will be defined as time from randomisation until death fom any cause in the intention to treat population
• Toxicity will be assessed throughout the treatment period using the National Cancer Institute Common Terminology Criteria for Adverse Events version three (NCI CTCAE v3.0)

The purpose of this study is to determine whether there is greater activity for carboplatin than a taxane standard of care (docetaxel) in women with ER-, PR- and HER2- breast cancer. The trial aims to recruit between 370 and 450 patients.

• Drug: Carboplatin
  AUC 6 every 3 weeks for six cycles (18 weeks)
• Drug: Docetaxel
  100mg/m2 every 3 weeks for six cycles (18 weeks)

• Experimental: Arm A
  Carboplatin
  Intervention: Drug: Carboplatin
• Active Comparator: Arm B
  Docetaxel
  Intervention: Drug: Docetaxel

Inclusion Criteria:

• Histologically confirmed ER-, PR-, primary breast cancer
• Histologically confirmed HER2- primary breast cancer
• Measurable confirmed metastatic or recurrent locally advanced disease unsuitable for local therapy but suitable for taxane chemotherapy
• Patients with stable, treated bain metastases will be eligible providing informed consent can be given and that other sites of measurable disease are present.
• Patients with bone metastases currently receiving bisphosphonates for palliation will be eligible providing informed consent can be given and that other sites of measurable disease are present
• ECOG Performance Status 0, 1, or 2
• Adequate haematology, biochemical indices (FBC, U & Es)
• LFTs = Normal bilirubin, AST and/or ALT = 3 x ULN if Alk Phos >5 x ULN (or an isolated elevation AST/ALT of ≤5 x ULN
• Adequate renal function - Creatinine clearance of >25mls per minute
• Written informed consent, able to comply with treatment and follow up

Exclusion Criteria:

• Original primary tumour or subsequent relapse known to be positive for any of ER, PR, or HER2 receptors
• Patients unfit for chemotherapy or those with neuropathy >grade 1 (sensory or motor)
• Known allergy to platinum compounds or to mannitol
• Known sensitivity to taxanes
• Patients with inoperable locally advanced disease suitable for local radiotherapy or an anthracycline containing regimen
• Previous chemotherapy for metastatic disease other than an anthracycline as in inclusion criteria above
• Previous exposure to a taxane in adjuvant chemotherapy within 12 months of trial entry
• Previous treatment with a taxane for recurrent locally advanced disease
• Previous treatment with a platinum chemotherapy drug
• LFTs = Abnormal bilirubin (> ULN), AST and/or ALT >3 X ULN and Alk Phos >5 x ULN (or an isolated elevation AST/ALT of >5 x ULN)
• Patients with a life expectancy of less than 3 months
• Previous malignancies other than adequately treated in situ carcinoma of the uterine cervix or basal or squamous call carcinoma of the skin, unless there has been a disease free interval of at least 10 years
• Previous or synchronous second breast cancer (unless also confirmed ER-, PR- and HER2-)
• Patients with bone limited disease
• Other serious uncontrolled medical conditions or concurrent medical illness likely to compromise life expectancy and/or the completion of trial therapy
• Pregnant, lactating or potentially childbearing women not using adequate contraception

• King's College London
• Cancer Research UK
• Breakthrough Breast Cancer