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

Kang, Yuan; Si, Yiran; An, Guangyu; Yuan, Peng

doi:10.21037/gs-20-593

Cited by 7 publications

(4 citation statements)

References 36 publications

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“…[ 6 ] Cyclophosphamide is a nitrogen mustard drug that plays an important role in breast cancer and blood disorders. [ 7 ] Jensen et al reported erythema (n = 10, 22%) and ulceration (n = 7, 16%) in 45 breast cancer patients treated with cyclophosphamide and epirubicin, respectively. [ 8 ] Doxorubicin is a commonly used anthracycline antitumor drug in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Esophageal stenosis after chemotherapy for breast cancer

Ren

Yin

et al. 2022

Medicine

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Rationale: Esophageal stenosis after chemotherapy in breast cancer patients is rare. Distinguishing esophageal stenosis from esophageal metastasis caused by breast cancer is important. Patient concerns and diagnosis:A 62-year-old woman diagnosed with advanced breast cancer and no distant metastases gradually developed skin changes, oral ulcers and mucosal injures after four cycles of chemotherapy. Dysphagia was the most severe symptom that greatly affected the patient's quality of life. Ultimately, esophageal stenosis and ulceration were confirmed by serial radiological examinations and endoscopic biopsy.Interventions: Due to difficulties in eating orally, the patient was initially placed on a nasogastric tube in order to improve her nutritional status. Simultaneously, she was administered powerful proton pump inhibitors. She underwent modified radical mastectomy for breast cancer after her nutritional status improved. However, the patient was still suffering from severe dysphagia after more than 4 months of follow-up. Subsequently, she underwent removable esophageal stent implantation after after unsuccessful attempts to dilate her esophagus.Outcomes: The dysphagia symptoms were immediately alleviated to a certain degree, and the dilated cavity of the upper esophagus showed slight retraction.Lessons: Esophageal stenosis is very infrequent in patients with breast cancer after chemotherapy. It needs to be. distinguished from esophageal metastasis caused by breast cancer. Esophageal stent implantation may provide benefits in terms of both symptom control and survival in patients with severe esophageal structures.

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Section: Discussionmentioning

confidence: 99%

Esophageal stenosis after chemotherapy for breast cancer

Ren

Yin

et al. 2022

Medicine

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“…15,16 However, research has repeatedly demonstrated that it also contributes substantially to the risk of gonadotoxic effects, especially in premenopausal women. 17,18 Previous meta-analysis 19 compared the efficacy and safety of anthracycline plus taxane-based neoadjuvant chemotherapy in patients with breast cancer. The results showed that the anthracycline plus taxanebased neoadjuvant chemotherapy regimen with or without cyclophosphamide had similar clinical outcomes in patients with breast cancer, and the addition of cyclophosphamide could increase the risks of thrombocytopenia, sensory and/or motor neuropathy, and nausea and vomiting.…”

Section: Jama Network Open | Oncologymentioning

confidence: 99%

Effect of Epirubicin Plus Paclitaxel vs Epirubicin and Cyclophosphamide Followed by Paclitaxel on Disease-Free Survival Among Patients With Operable ERBB2-Negative and Lymph Node–Positive Breast Cancer

Yuan

Kang

et al. 2023

JAMA Netw Open

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ImportanceAdjuvant therapy is an important and effective treatment for breast cancer. However, there is a lack of head-to-head clinical trials comparing the regimens epirubicin plus paclitaxel (EP) vs epirubicin and cyclophosphamide followed by paclitaxel (EC-P) in breast cancer.ObjectiveTo evaluate the noninferiority of a cyclophosphamide-free (EP) regimen compared with the standard EC-P regimen for patients with operable hormone receptor–positive, ERBB2 (formerly HER2)-negative, lymph node–positive breast cancer.Design, Setting, and ParticipantsThis prospective, open-label, phase 3, noninferiority randomized clinical trial was conducted from June 1, 2010, to June 30, 2016, in the Cancer Hospital, Chinese Academy of Medical Sciences, Beijing. Patients with hormone receptor–positive, ERBB2-negative, lymph node–positive operable breast cancer were included and randomized into 2 treatment groups. Data were analyzed from June 30, 2016, to November 1, 2022.InterventionsPatients received adjuvant epirubicin (75 mg/m2) and paclitaxel (175 mg/m2) every 3 weeks for 6 cycles (EP regimen) or epirubicin (90 mg/m2) and cyclophosphamide (600 mg/m2) every 3 weeks for 4 cycles followed by paclitaxel (175 mg/m2) every 3 weeks for 4 cycles (EC-P regimen) as the intention-to-treat (ITT) population.Main Outcomes and MeasuresThe primary outcome was disease-free survival (DFS), and the secondary outcomes included overall survival (OS), distant DFS, and safety.ResultsA total of 900 patients were registered, and 813 eligible patients (median age, 48 [IQR, 41-56] years) were randomly assigned to the EP group (n = 407) or the EC-P group (n = 406) after the surgical procedure. Through a median follow-up of 93.6 (IQR, 60.9-114.1) months, the hazard ratio (HR) of DFS for EP vs EC-P was 0.82 (95% CI, 0.62-1.10; 5-year DFS, 86.0% vs 80.6%; noninferior P = .001). The 5-year OS for the ITT population treated with the EP or the EC-P regimen was 94.7% vs 95.0%, respectively (HR, 0.95 [95% CI, 0.61-1.49]). Patients in the EP group had more frequent toxic effect events than those in the EC-P group.Conclusions and RelevanceIn this prospective, open-label, phase 3, randomized clinical trial, the EP regimen was noninferior to the EC-P regimen. These findings supported that the EP regimen could be an effective adjuvant chemotherapy regimen for women with ERBB2-negative breast cancer.Trial RegistrationClinicalTrials.gov Identifier: NCT01134523

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“…Cyclophosphamide (CPA) is one of the alkylating agents that is used on a wide scale for the treatment of breast, ovarian, and hematologic malignancies [1]. In addition, it exhibits potent immunosuppressive properties that are clinically applied for the management of several pathological conditions characterized by an immunological nature [2].…”

Section: Introductionmentioning

confidence: 99%

Amentoflavone Mitigates Cyclophosphamide-Induced Pulmonary Toxicity: Involvement of -SIRT-1/Nrf2/Keap1 Axis, JAK-2/STAT-3 Signaling, and Apoptosis

Balaha,

Alamer,

Aldossari

et al. 2023

Medicina

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Background and objectives: Cyclophosphamide (CPA) is an alkylating agent that is used for the management of various types of malignancies and as an immunosuppressive agent for the treatment of immunological disorders. However, its use is limited by its potential to cause a wide range of pulmonary toxicities. Amentoflavone (AMV) is a flavonoid that had proven efficacy in the treatment of disease states in which oxidative stress, inflammation, and apoptosis may play a pathophysiologic role. This study investigated the potential ameliorative effects of the different doses of AMV on CPA-induced pulmonary toxicity, with special emphasis on its antioxidant, anti-inflammatory, and apoptosis-modulating effects. Materials and methods: In a rat model of CPA-induced pulmonary toxicity, the effect of AMV at two dose levels (50 mg/kg/day and 100 mg/kg/day) was investigated. The total and differential leucocytic counts, lactate dehydrogenase activity, and levels of pro-inflammatory cytokines in the bronchoalveolar lavage fluid were estimated. Also, the levels of oxidative stress parameters, sirtuin-1, Keap1, Nrf2, JAK2, STAT3, hydroxyproline, matrix metalloproteinases 3 and 9, autophagy markers, and the cleaved caspase 3 were assessed in the pulmonary tissues. In addition, the histopathological and electron microscopic changes in the pulmonary tissues were evaluated. Results: AMV dose-dependently ameliorated the pulmonary toxicities induced by CPA via modulation of the SIRT-1/Nrf2/Keap1 axis, mitigation of the inflammatory and fibrotic events, impaction of JAK-2/STAT-3 axis, and modulation of the autophagic and apoptotic signals. Conclusions: AMV may open new horizons towards the mitigation of the pulmonary toxicities induced by CPA.

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

Cited by 7 publications

References 36 publications

Esophageal stenosis after chemotherapy for breast cancer

Esophageal stenosis after chemotherapy for breast cancer

Effect of Epirubicin Plus Paclitaxel vs Epirubicin and Cyclophosphamide Followed by Paclitaxel on Disease-Free Survival Among Patients With Operable ERBB2-Negative and Lymph Node–Positive Breast Cancer

Amentoflavone Mitigates Cyclophosphamide-Induced Pulmonary Toxicity: Involvement of -SIRT-1/Nrf2/Keap1 Axis, JAK-2/STAT-3 Signaling, and Apoptosis

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