{ "id": "epwgh70t69", "slug": "carboplatin-and-trastuzumab-regimen", "title": "Carboplatin and trastuzumab regimen", "updated": "2026-10-15", "topic_path": [ { "id": "life", "label": "Life and health", "api_url": "https://www.edgepedia.org/api/v1/topics/life" }, { "id": "life.health", "label": "Human health and medicine", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health" }, { "id": "life.health.medicines", "label": "Medicines and therapeutics", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.medicines" }, { "id": "life.health.medicines.cancer-chemotherapy", "label": "Cancer chemotherapy and regimens", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.medicines.cancer-chemotherapy" }, { "id": "life.health.medicines.cancer-chemotherapy.immunotherapy-and-immunochemotherapy", "label": "Immunotherapy and immunochemotherapy", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.medicines.cancer-chemotherapy.immunotherapy-and-immunochemotherapy" } ], "geo": [ { "id": "geo.nongeo.t1946.life.health.medicines.cancer-chemotherapy", "label": "Non-geographic · 1946 to 2000: Cancer chemotherapy and regimens", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life.health.medicines.cancer-chemotherapy", "path": [ { "id": "geo.nongeo", "label": "Non-geographic", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo" }, { "id": "geo.nongeo.t1946", "label": "Non-geographic · 1946 to 2000", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946" }, { "id": "geo.nongeo.t1946.life", "label": "Life and health", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life" }, { "id": "geo.nongeo.t1946.life.health", "label": "Human health and medicine", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life.health" }, { "id": "geo.nongeo.t1946.life.health.medicines", "label": "Medicines and therapeutics", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life.health.medicines" }, { "id": "geo.nongeo.t1946.life.health.medicines.cancer-chemotherapy", "label": "Cancer chemotherapy and regimens", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t1946.life.health.medicines.cancer-chemotherapy" } ] } ], "excerpt": "The carboplatin and trastuzumab regimen pairs the platinum chemotherapy carboplatin with the anti-HER2 antibody trastuzumab, usually with a taxane, and is used mainly in HER2-positive breast cancer.", "snippet": "The carboplatin and trastuzumab regimen pairs the platinum chemotherapy carboplatin with the anti-HER2 antibody trastuzumab, usually with a taxane, and is used mainly in HER2-positive breast cancer.", "node": "life.health.medicines.cancer-chemotherapy.immunotherapy-and-immunochemotherapy", "markdown": "# Carboplatin and trastuzumab regimen\n\nThe carboplatin and trastuzumab regimen is a cancer treatment combination that pairs the platinum chemotherapy drug carboplatin with trastuzumab, a monoclonal antibody against HER2, usually together with a taxane such as docetaxel. It is used mainly in HER2-positive breast cancer across neoadjuvant (before surgery), adjuvant (after surgery), and metastatic settings. The best-known form is the TCH regimen of docetaxel, carboplatin, and trastuzumab, a non-anthracycline adjuvant option for HER2-positive early breast cancer.[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383) • [2](https://www.biospace.com/the-b-cancer-international-research-group-b-release-first-taxane-based-non-anthracycline-containing-chemotherapy-in-combination-with-herceptin-tc) With pertuzumab added, the combination becomes TCHP or TCbHP, a standard neoadjuvant regimen for HER2-positive breast cancer.[3](https://www.dovepress.com/bridging-clinical-trials-to-real-world-clinical-practice-tchp-neoadjuv-peer-reviewed-fulltext-article-BCTT)\n\n| Key fact | Detail |\n|---|---|\n| Drugs combined | Carboplatin (platinum chemotherapy) plus trastuzumab (anti-HER2 antibody), usually with docetaxel or another taxane[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383) |\n| Standard adjuvant/neoadjuvant schedule | Docetaxel 75 mg/m² plus carboplatin AUC 6 every 3 weeks for six cycles, with trastuzumab continued to complete 1 year[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383) |\n| Pivotal trial | BCIRG-006 randomized 3222 women with HER2-positive early breast cancer to AC-T, AC-TH, or TCH[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383) |\n| Adjuvant efficacy (TCH arm) | 5-year disease-free survival 81%, overall survival 91%[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383) |\n| Neoadjuvant pCR | 55.9% with TCH versus 37.3% with anthracycline-containing EC-TH in the neoCARH trial[4](https://sage.cnpereading.com/doi/10.1177/17588359211009003) |\n| Signature toxicity | Thrombocytopenia, the characteristic carboplatin effect (25.0% with TCH vs 7.5% with EC-TH)[4](https://sage.cnpereading.com/doi/10.1177/17588359211009003) |\n| Cardiac advantage | Congestive heart failure and cardiac dysfunction were significantly higher with anthracycline plus trastuzumab than with TCH (P<0.001)[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383) |\n\n## How it works\n\nThe rationale for combining carboplatin and trastuzumab comes from preclinical work showing synergy between trastuzumab and platinum salts or docetaxel that was not seen with anthracyclines or paclitaxel.[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383) The combination was also designed to avoid anthracycline-related cardiac toxicity, which is a particular concern when trastuzumab is given.[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383)\n\n## How it is done\n\nIn the adjuvant TCH schedule established in BCIRG-006, patients received docetaxel 75 mg/m² plus carboplatin at an area under the concentration-time curve (AUC) of 6 mg/mL per minute, given every 3 weeks for six cycles concurrently with trastuzumab, followed by trastuzumab for an additional 34 weeks to complete one year of antibody therapy.[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383) [Trastuzumab](https://www.edgepedia.org/trastuzumab) in that trial was started at 4 mg/kg, continued at 2 mg/kg weekly during chemotherapy, and then given as 6 mg/kg every 3 weeks.[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383) In the trial's infusion procedures, trastuzumab was given intravenously over 30 to 90 minutes, docetaxel over 1 hour, and carboplatin over 30 to 60 minutes, with treatment repeating every 21 days.[5](https://clinicaltrials.gov/study/NCT00047255)\n\nCarboplatin is dosed by AUC rather than by body surface area, using the patient's kidney function; the AUC 6 starting dose is calculated from the glomerular filtration rate, and when calculated creatinine clearance is used the recommended maximum dose at AUC 6 is 900 mg.[6](https://www.uhs.nhs.uk/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/Carboplatin-Docetaxel-Pertuzumab-Trastuzumab-IV-SC.pdf) When pertuzumab is added (TCHP/TCbHP), pertuzumab is given at an 840 mg loading dose then 420 mg maintenance, with trastuzumab at 8 mg/kg loading then 6 mg/kg, every 3 weeks for up to six cycles.[3](https://www.dovepress.com/bridging-clinical-trials-to-real-world-clinical-practice-tchp-neoadjuv-peer-reviewed-fulltext-article-BCTT)\n\nMonitoring includes a cardiac function (left ventricular ejection fraction, LVEF) assessment before starting treatment and every 9 to 12 weeks thereafter, a full blood count, urea and electrolytes, and liver function tests before each cycle, and blood pressure before each trastuzumab administration.[6](https://www.uhs.nhs.uk/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/Carboplatin-Docetaxel-Pertuzumab-Trastuzumab-IV-SC.pdf)\n\n## Origin\n\nThe pivotal evidence for the combination came from the BCIRG-006 trial (registry NCT00047255), which randomized 3222 women with HER2-positive early-stage breast cancer to three arms: doxorubicin and cyclophosphamide followed by docetaxel (AC-T), the same regimen plus 52 weeks of trastuzumab (AC-TH), or the non-anthracycline TCH regimen of docetaxel, carboplatin, and 52 weeks of trastuzumab, in which trastuzumab was started concomitantly with chemotherapy.[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383) • [7](https://www.sec.gov/Archives/edgar/data/1121404/000090342305000712/ex99-2_0916.htm) At a median follow-up of 65 months, 5-year disease-free survival was 75% with AC-T, 84% with AC-TH, and 81% with TCH, and overall survival was 87%, 92%, and 91% respectively.[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383) Based on this study, the US FDA approved docetaxel (Taxotere) and carboplatin combined with trastuzumab (Herceptin) for adjuvant treatment of HER2-positive early breast cancer, announced by the Cancer International Research Group, a division of TRIO; the AC-TH regimen was approved at the same time.[2](https://www.biospace.com/the-b-cancer-international-research-group-b-release-first-taxane-based-non-anthracycline-containing-chemotherapy-in-combination-with-herceptin-tc)\n\n## Variants\n\nSeveral schedules exist. The three-weekly TCH schedule uses docetaxel 75 mg/m² with carboplatin AUC 6 for six cycles.[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383) A weekly variant tested in metastatic disease uses nanoparticle albumin-bound (nab-) paclitaxel 100 mg/m² and carboplatin AUC 2 on days 1, 8, and 15 of a 28-day cycle, with weekly trastuzumab 2 mg/kg after a 4 mg/kg loading dose.[8](https://pmc.ncbi.nlm.nih.gov/articles/PMC3883128/) A weekly neoadjuvant variant pairs paclitaxel 80 mg/m² with carboplatin AUC 2 and every-3-week trastuzumab and pertuzumab for 12 weeks.[9](https://www.springermedicine.com/breast-cancer/neutropenia/neoadjuvant-weekly-paclitaxel-and-carboplatin-with-trastuzumab-a/21544922) In TCbHP, the taxane can be docetaxel 75 mg/m², paclitaxel 175 mg/m², or nab-paclitaxel 260 mg/m², all with carboplatin AUC 6 every 3 weeks for six cycles.[10](https://ascopubs.org/doi/10.1200/JCO-25-02176) The carboplatin-free THP variant uses docetaxel 100 mg/m², a dose selected on the basis of the BCIRG-007 study, where this intensity was used to maintain efficacy in the absence of carboplatin.[10](https://ascopubs.org/doi/10.1200/JCO-25-02176)\n\n## Applications\n\nThe combination is used in all three major settings. In the neoadjuvant setting, the randomized phase II neoCARH trial found that six cycles of TCH achieved a pathologic complete response (pCR) in 55.9% of patients (38/68) versus 37.3% (25/67) with anthracycline-containing EC-TH (p = 0.032).[4](https://sage.cnpereading.com/doi/10.1177/17588359211009003) In the adjuvant setting, TCH produced 5-year disease-free survival of 81% and overall survival of 91% in BCIRG-006.[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383) In the metastatic first-line setting, a multicenter phase II trial evaluated weekly nab-paclitaxel with carboplatin and weekly trastuzumab in women with HER2-overexpressing metastatic breast cancer.[8](https://pmc.ncbi.nlm.nih.gov/articles/PMC3883128/) With pertuzumab added, TCbHP has become a standard neoadjuvant regimen.[3](https://www.dovepress.com/bridging-clinical-trials-to-real-world-clinical-practice-tchp-neoadjuv-peer-reviewed-fulltext-article-BCTT)\n\n## Limitations and alternatives\n\nThe signature toxicity of the carboplatin component is thrombocytopenia. In neoCARH, thrombocytopenia occurred in 25.0% of TCH patients versus 7.5% with EC-TH (\\( p = 0.006 \\)), while neutropenia and anemia were similar between arms.[4](https://sage.cnpereading.com/doi/10.1177/17588359211009003) In a real-world cohort of 162 patients, grade 3 to 4 thrombocytopenia (13.7% vs 0%) and anemia (9.8% vs 0%) occurred exclusively in the carboplatin-containing TCHP/TCH group, whereas grade 3 to 4 neutropenia was more frequent with anthracycline regimens (18.0% vs 3.9%).[11](https://link.springer.com/article/10.1186/s13058-026-02312-w) [Carboplatin](https://www.edgepedia.org/carboplatin) adverse effects also include neuropathy, nephrotoxicity, and ototoxicity.[6](https://www.uhs.nhs.uk/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/Carboplatin-Docetaxel-Pertuzumab-Trastuzumab-IV-SC.pdf) [Hypersensitivity](https://www.edgepedia.org/hypersensitivity) reactions to platinum agents can occur; patients who react can sometimes continue treatment through desensitization, using either a 12-step outpatient protocol with antihistamines, corticosteroids, and a leukotriene receptor antagonist, in which 42% of 186 desensitized patients had breakthrough reactions and only 4 required epinephrine, or a four-bag dilution protocol giving 1:1,000, 1:100, 1:10, and full-strength doses sequentially.[12](https://pmc.ncbi.nlm.nih.gov/articles/PMC9924431/) • [13](https://www.ejgo.org/pdf/10.3802/jgo.2026.37.e11)\n\nAgainst anthracycline-[trastuzumab regimens](https://www.edgepedia.org/trastuzumab-regimen), the carboplatin combination trades myelotoxicity for less cardiac risk. In BCIRG-006, congestive heart failure and cardiac dysfunction were significantly higher with AC-TH than with TCH (\\( P < 0.001 \\)), and eight cases of acute leukemia were reported, seven in the anthracycline-based groups.[1](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383)\n\nThe main recent change is the demonstrated equivalence of carboplatin-free dual-blockade therapy. In the randomized phase III neoCARHP trial (774 patients with stage II to III HER2-positive breast cancer, enrolled April 2021 to August 2024), pCR was 64.1% with carboplatin-free THP versus 65.9% with TCbHP, an absolute difference of −1.8% meeting noninferiority (P=.0089), and grade 3 to 4 adverse events were fewer with THP (20.7% vs 34.6%).[10](https://ascopubs.org/doi/10.1200/JCO-25-02176) The 2024 Chinese Society of Clinical Oncology guidelines list both six-cycle TCbHP and THP as category I recommendations, with TCbHP preferred and THP considered for patients over 60 years of age,[14](https://gs.amegroups.org/article/view/156012/html) and a 2025 Chinese expert consensus similarly recommends six cycles of TCbHP as the preferred neoadjuvant regimen, with THP for patients over 60, with low tumor burden, or unable to tolerate platinum.[15](https://www.ovid.com/jnls/tbcr/fulltext/10.21037/tbcr-25-34~chinese-expert-consensus-on-clinical-diagnosis-and-treatment) Antibody-drug conjugates are an emerging alternative: trastuzumab deruxtecan has shown positive neoadjuvant (DESTINY-Breast11) and adjuvant (DESTINY-Breast05) results, and the ADC SHR-A1811 achieved a pCR of 63.2% versus 64.4% with TCbHP in a phase II trial; the neoCARHP authors conclude that THP remains the most evidence-based carboplatin-free alternative for early-stage HER2-positive breast cancer while ADCs may reshape treatment algorithms.[10](https://ascopubs.org/doi/10.1200/JCO-25-02176)\n\n## References\n\n1. [Adjuvant Trastuzumab in HER2-Positive Breast Cancer (BCIRG-006)](https://www.nejm.org/doi/full/10.1056/NEJMoa0910383)\n2. [CIRG Release: First Taxane-Based Non-Anthracycline Chemotherapy with Herceptin (TCH) Obtains FDA Approval](https://www.biospace.com/the-b-cancer-international-research-group-b-release-first-taxane-based-non-anthracycline-containing-chemotherapy-in-combination-with-herceptin-tc)\n3. [Bridging Clinical Trials to Real-World Clinical Practice: TCHP Neoadjuvant Therapy (BCTT, Dove Medical Press)](https://www.dovepress.com/bridging-clinical-trials-to-real-world-clinical-practice-tchp-neoadjuv-peer-reviewed-fulltext-article-BCTT)\n4. [Anthracycline-containing versus carboplatin-containing neoadjuvant chemotherapy in combination with trastuzumab for HER2-positive breast cancer: the neoCARH phase II randomized clinical trial](https://sage.cnpereading.com/doi/10.1177/17588359211009003)\n5. [Docetaxel and Trastuzumab With or Without Carboplatin in Treating Women With HER2-Positive Breast Cancer (BCIRG-006)](https://clinicaltrials.gov/study/NCT00047255)\n6. [Carboplatin (AUC6)-Docetaxel-Pertuzumab-Trastuzumab (IV/SC) chemotherapy protocol](https://www.uhs.nhs.uk/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/Carboplatin-Docetaxel-Pertuzumab-Trastuzumab-IV-SC.pdf)\n7. [Genentech SEC filing exhibit on Herceptin TCH and AC-TH regimens](https://www.sec.gov/Archives/edgar/data/1121404/000090342305000712/ex99-2_0916.htm)\n8. [Phase II Trial of Weekly Nanoparticle Albumin-Bound Paclitaxel With Carboplatin and Trastuzumab as First-line Therapy for HER2-Overexpressing Metastatic Breast Cancer](https://pmc.ncbi.nlm.nih.gov/articles/PMC3883128/)\n9. [Neoadjuvant weekly paclitaxel and carboplatin with trastuzumab and pertuzumab in HER2-positive breast cancer: a BrUOG study](https://www.springermedicine.com/breast-cancer/neutropenia/neoadjuvant-weekly-paclitaxel-and-carboplatin-with-trastuzumab-a/21544922)\n10. [Neoadjuvant Taxane Plus Trastuzumab and Pertuzumab With or Without Carboplatin in HER2-Positive Breast Cancer: The Randomized Noninferiority Phase III neoCARHP Trial](https://ascopubs.org/doi/10.1200/JCO-25-02176)\n11. [Neoadjuvant anthracycline-free versus anthracycline-containing chemotherapy combined with dual HER2 blockade in HER2-positive breast cancer: a real-world comparative study](https://link.springer.com/article/10.1186/s13058-026-02312-w)\n12. [Safety and efficacy of an outpatient 12-step desensitization protocol for antineoplastic agents](https://pmc.ncbi.nlm.nih.gov/articles/PMC9924431/)\n13. [Current status of carboplatin desensitization therapy for gynecologic cancers](https://www.ejgo.org/pdf/10.3802/jgo.2026.37.e11)\n14. [Comparison of neoadjuvant TCbHP versus THP in HER2-positive breast cancer: a retrospective cohort study (Gland Surgery)](https://gs.amegroups.org/article/view/156012/html)\n15. [Chinese expert consensus on clinical diagnosis and treatment (Translational Breast Cancer Research)](https://www.ovid.com/jnls/tbcr/fulltext/10.21037/tbcr-25-34~chinese-expert-consensus-on-clinical-diagnosis-and-treatment)\n\n---\n*Topic: Encyclopedia › Life and health › Human health and medicine › Medicines and therapeutics › Cancer chemotherapy and regimens › Immunotherapy and immunochemotherapy*\n\n*Initially written Sep 29, 2026 · Edited: Oct 15, 2026*\n\n*Copyright 2026 EdgeChat AI, a subsidiary of Biostate AI.*\n\nLicense: Edgepedia Community License 1.0, https://www.edgepedia.org/edgepedia/license\n", "same_as": [], "url": "https://www.edgepedia.org/carboplatin-and-trastuzumab-regimen", "markdown_url": "https://www.edgepedia.org/carboplatin-and-trastuzumab-regimen.md", "license": { "name": "Edgepedia Community License 1.0", "url": "https://www.edgepedia.org/edgepedia/license", "summary": "Free with credit, commercial use included. AI training is open to everyone. For other uses, organizations over USD 100M in revenue or 100M monthly users license separately.", "spdx": "LicenseRef-Edgepedia-Community-1.0" }, "credit": "\"Carboplatin and trastuzumab regimen\", Edgepedia (EdgeChat), https://www.edgepedia.org/carboplatin-and-trastuzumab-regimen. Edgepedia Community License 1.0.", "credit_md": "\"[Carboplatin and trastuzumab regimen](https://www.edgepedia.org/carboplatin-and-trastuzumab-regimen)\", Edgepedia (EdgeChat), [https://www.edgepedia.org/carboplatin-and-trastuzumab-regimen](https://www.edgepedia.org/carboplatin-and-trastuzumab-regimen). [Edgepedia Community License 1.0](https://www.edgepedia.org/edgepedia/license).", "credit_html": "\"Carboplatin and trastuzumab regimen\", Edgepedia (EdgeChat), https://www.edgepedia.org/carboplatin-and-trastuzumab-regimen. Edgepedia Community License 1.0.", "speakable": "The carboplatin and trastuzumab regimen pairs the platinum chemotherapy carboplatin with the anti-HER2 antibody trastuzumab, usually with a taxane, and is used mainly in HER2-positive breast cancer." }