Comparison of neoadjuvant adriamycin and docetaxel versus adriamycin, cyclophosphamide followed by paclitaxel in patients with operable breast cancer

Abstract

PurposeNeoadjuvant chemotherapy is the standard treatment for patients with locally advanced breast cancer and is increasingly considered for patients with operable disease. Recently, as many clinical trials have demonstrated favorable outcomes of anthracycline-taxane based regimen, this approach has been widely used in the neoadjuvant setting.MethodsWe compared women who received adriamycine and docetaxel (AD) with adriamycin, cyclophosphamide followed by paclitaxel (AC-T) as neoadjuvant chemotherapy. The AD group was scheduled for six cycles of AD (50 mg/m2 and 75 mg/m2, respectively) at a 3-week interval. The AC-T group was scheduled for four cycles of adriamycin and cyclophosphamide (50 mg/m2 and 500 mg/m2, respectively) followed by four cycles of paclitaxel (175 mg/m2) at a 3-week interval.ResultsThe responses of chemotherapy were equivalent (overall response rate [AD, 75.7% vs. AC-T, 80.9%; P = 0.566], pathologic complete response [pCR] rate [breast and axilla: AD, 10.8% vs. AC-T, 12.8%; P = 1.000; breast only: AD, 18.9% vs. AC-T, 14.9%, P = 0.623], breast conserving surgery rate [P = 0.487], and breast conserving surgery conversion rate [P = 0.562]). The pCR rate in the breast was higher in the human epidermal growth factor receptor 2 (HER2) positive cases (HER2 positive 33.3% vs. negative 10%, P = 0.002). Although nonhematologic toxicities were comparable, hematologic toxicities were more severe in the AD group. Most women in the AD group suffered from grade 3/4 neutropenia (P < 0.001) and neutropenic fever (P < 0.001).ConclusionTumor responses were not different in various variables between the two groups. However, AC-T was a more tolerable regimen than AD in patients with breast cancer receiving neoadjuvant chemotherapy.

Alteronol induces cell cycle arrest and apoptosis via increased reactive oxygen species production in human breast cancer T47D cells

“…Paclitaxel (PTX) is a kind of natural antitumour drug from the bark of the yew tree, which has unique pharmacological effects and used as the first‐line and second‐line chemotherapy drug for breast cancer, ovarian cancer and non‐small cell lung cancer, as well as it can be used in the treatment of head and neck cancer, oesophageal cancer . Although paclitaxel is sensitive and effective for breast cancer, it has many toxic reactions, such as allergic reaction, myelosuppression and neurotoxicity .…”

Efficacy and safety of cyclophosphamide in anthracycline- and taxane-based neoadjuvant chemotherapy in breast cancer: a meta-analysis

“…After removing the studies with irrelevant topic or in non-English language, 171 articles were potentially eligible. After another round of screening, four eligible studies with 2,302 early-stage breast cancer patients were finally included in the quantitative synthesis (12)(13)(14)(15). The assessment of Cochrane risk of bias was illustrated in Figure 2.…”

Comparison of adjuvant ED and EC-D regimens in operable breast invasive ductal carcinoma

“…They found that after a median follow-up of 35.5 months, the DFS of the two arms was similar (log-rank, P=0.719) and that the incidence of treatment-related toxicity did not differ significantly ( 15 ). Moreover, Hong et al ( 16 ) reported that there was no significant difference in treatment response between AD (50/75 mg/m 2 adriamycin/docetaxel at a 3-week interval for 4 cycles each) and AC-T (50/500 mg/m 2 adriamycin/cyclophosphamide followed by 175 mg/m 2 paclitaxel at a 3-week interval for 4 cycles each) as NAC in patients with operable breast cancer ( 16 ). Both of the aforementioned studies showed no inferiority in the short-term therapeutic effects of concurrent treatment, which was consistent with our results.…”

“…The concurrent administration of anthracyclines and taxanes hyas been reported to have more severe hematological toxicities compared to sequential and anthracycline-based regimens ( 6 , 16 ). The primary prophylactic use of G-CSF based on National Comprehensive Cancer Network guidelines for a higher risk of febrile neutropenia (FN) was also recommended ( 6 , 17 ).…”

“…The above-mentioned ongoing phase III randomized trial based on Chinese patients comparing ET and EC-T also reported no significant difference in toxicities, including grade 3/4 neutropenia, in their primary results ( 15 ). However, another study on Korean patients suggested that the AD regimen was associated with a significantly higher incidence of FN and grade 3/4 neutropenia compared with the AC-T regimen in the neoadjuvant setting ( 16 ). The study used docetaxel at a 3-week interval in the AD group and paclitaxel at a 3-week interval in the AC-T group.…”