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Sequential Chemotherapy Benefits Node-positive Breast Cancer Patients

Women with operable node-positive breast cancer experienced a survival benefit from sequential administration of doxorubicin, cyclophosphamide, and Taxotere® (docetaxel). These findings were recently published in The New England Journal of Medicine.[1]

Effective treatment of node-positive breast cancer often involves both local and systemic therapy. Local therapy consists of surgery and/or radiation and is directed at removing or destroying cancer cells in or near the breast. Systemic therapy is directed at destroying cancer cells throughout the body, and may include chemotherapy, targeted therapy, and/or hormonal therapy.

Anthracycline and taxane chemotherapy drugs are commonly used in the treatment of breast cancer. To compare three different approaches to administering chemotherapy, researchers conducted a study known as the National Surgical Adjuvant Breast and Bowel Project B-30 trial.

In this multicenter Phase III trial, 5,351 breast cancer patients with node-positive disease who had undergone total mastectomy or lumpectomy were randomized to receive eight cycles of treatment with sequential doxorubicin, cyclophosphamide, and Taxotere (ACT) over 24 weeks, concurrent TAC over 12 weeks, or a regimen of doxorubicin/Taxotere over 12 weeks.  In the concurrent TAC arm, all three drugs were administered together; in the sequential ACT arm, doxorubicin and cyclophosphamide were administered followed by Taxotere. After a median follow-up of six years, disease-free survival and overall survival were improved in the sequential ACT arm.

  • Overall survival was 83% in the sequential ACT arm, 79% in the concurrent ACT arm, and 79% in the doxorubicin/Taxotere arm.
  • Disease-free survival was 74% in the sequential ACT arm, 69% in the concurrent TAC arm, and 69% in the doxorubicin/Taxotere arm.

The researchers concluded that sequential administration of ACT provided a statistically significant 17% reduction in mortality compared with doxorubicin/Taxotere and a nonsignificant 14% reduction in mortality compared with the concurrent TAC arm. In addition, patients who experienced amenorrhea (absence of menstrual bleeding) for six months or more experienced an improved overall survival in all arms of the study.  The clinical significance of this finding is uncertain, but it of great interest and will lead to further investigation.  Studies are ongoing that continue to evaluate strategies to improve treatment for node-positive breast cancer patients.

Reference:



[1] Swain SM, Jeong J-H, Geyer CE, et al. Longer therapy, Iatrogenic amenorrhea, and survival in early breast cancer. New England Journal of Medicine. 2010; 362:2053–65.