Sequential docetaxel as adjuvant chemotherapy for node-positive or/and T3 or T4 breast cancer: clinical outcome (Mansoura University)

Abstract

This trial compared 6 cycles of fluorouracil, epirubicin, and cyclophosphamide (FEC) with a sequential regimen of 3 cycles of FEC followed by 3 cycles of docetaxel (FEC-D) as adjuvant treatment for women with node-positive or/and T3 or T4 breast cancer. Between January 2006 and January 2010, 657 patients with operable breast cancer were randomly assigned to either FEC every 21 days for 6 cycles, or 3 cycles of FEC followed by 3 cycles of docetaxel, both given every 21 days. Radiotherapy was mandatory for all patients who had undergone breast conserving surgery. Radiation to the chest wall, supraclavicular area, was recommended following mastectomy. Hormone-receptor-positive patients received tamoxifen for 5 years after chemotherapy. The primary end point was 5-year disease-free survival (DFS). Median follow-up was 61 months. Five-year DFS rates were 74 % with FEC and 78 % with FEC-D (P = 0.013). Multivariate analysis adjusted for prognostic factors showed a 17 % reduction in the relative risk of relapse with FEC-D. Five-year overall survival rates were 85 % with FEC and 89.4 % with FEC-D, demonstrating a 27 % reduction in the relative risk of death (P = 0.014). The incidence of grade 3-4 neutropenia, the need for hematopoietic growth factor, and incidence of nausea/vomiting were higher with FEC. Docetaxel was associated with more febrile neutropenia, stomatitis, edema, and nail disorders. Though rare overall, there were fewer cardiac events after FEC-D, attributable mainly to the lower anthracycline cumulative dose. Sequential adjuvant chemotherapy with FEC followed by docetaxel significantly improves disease-free and overall survival in node-positive or/and T3 or T4 breast cancer patients. Although the magnitude of the benefit observed with FEC-D, differences in the toxicity profiles of FEC and FEC-D may influence the choice of treatment for patients.

Taxane-Based Regimens as Adjuvant Treatment for Breast Cancer: a Retrospective Study in Egyptian Cancer Patients

“…Significant relative risk reductions were observed in the hormone positive, HER2-positive, and Ki67 ≥20% (Coudert et al, 2012). This is consistent with an Egyptian study done by (Sakr et al, 2013) using the same regimen as the French trial. Five-year DFS rates were 74 % with FEC and 78 % with FEC-D (p=0.013).…”

“…An Australian study found that the Egyptian women had the highest breast cancer rates of all Middle Eastern immigrants to Australia (McCredie, 1994). Egyptian publications conducted in Egypt in the adjuvant breast cancer setting are scarce (Abd-El-Moneim et al, 2011;Hamza et al, 2011;Sakr et al, 2013) Over three decades Montemurro and (Montemurro and Aglietta, 2009). The feasibility of six cycles of either docetaxel plus cyclophosphamide (TC6) or sequential taxane and anthracycline regimen (T-FEC) in Japanese patients with HER2-negative early breast cancer, was assessed (Abe et al, 2014).…”

Effectiveness of an Adjuvant Chemotherapy Regimen for Early-Stage Breast Cancer

“…Of 4324 potentially relevant articles, 31 articles (24 trials) were included in this study. 7,8,14–22,30–49 The results of the quality assessment of the trials according to the Cochrane risk-of-bias tool are shown in eTable 1 in the Supplement. Twenty-one trials included only women and in 3 trials there was not a clear description of criteria about sex.…”

Single Institution trial of anthracycline- and taxane-based chemotherapy for operable breast cancer: The ASTER study

“…In the 1990s, taxanes were introduced in clinical practice, leading to more complex drug sequences and combinations. Indeed, the therapeutic arsenal could be enriched by regimens such as AC→T, TAC, FEC→D, and TC, which improved survival against previous standards . A parallel branch of research focused on neo‐adjuvant setting.…”