Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2009-03-10
Docetaxel With Cyclophosphamide Is Associated With an Overall Survival Benefit Compared With Doxorubicin and Cyclophosphamide: 7-Year Follow-Up of US Oncology Research Trial 9735.
Abstract
Purpose
We previously reported that four cycles of docetaxel/cyclophosphamide (TC) produced superior disease-free survival (DFS) compared with four cycles of doxorubicin/cyclophosphamide (AC) in early breast cancer. Older women are under-represented in adjuvant chemotherapy trials. In our trial 16% of patients were > or = 65 years. We now report 7-year results for DFS and overall survival (OS) as well as the impact of age, hormone receptor status, and HER2 status on outcome and toxicity.
Patients and methods
Patients were randomly assigned to receive either four cycles of standard-dose AC (60/600 mg/m(2); n = 510), or TC (75/600 mg/m(2); n = 506), administered by intravenous infusion every 3 weeks.
Results
The median age in women younger than 65, was 50 years (range, 27 to 64) and for women > or = 65 was 69 years (range, 65 to 77). Baseline characteristics in the two age subgroups were generally well matched, except that older women tended to have more lymph node involvement. At a median of 7 years follow-up, the difference in DFS between TC and AC was significant (81% TC v 75% AC; P = .033; hazard ratio [HR], 0.74; 95% CI 0.56 to 0.98) as was OS (87% TC v 82% AC; P = .032; HR, 0.69; 95% CI, 0.50 to 0.97). TC was superior in older patients as well as younger patients. There was no interaction of hormone-receptor status or HER-2 status and treatment. Older women experienced more febrile neutropenia with TC and more anemia with AC.
Conclusion
With longer follow-up, four cycles of TC was superior to standard AC (DFS and OS) and was a tolerable regimen in both older and younger patients.
Related Questions
When would you offer anthracycline based adjuvant chemotherapy for a T1cN0 TNBC?
Taxotere/Cytoxan (TC) 4 cycles would be a more reasonable standard adjuvant choice with proven DFS and OS advantage over AC (Jones et al, JCO 2009), and would avoid the risk of cardiotoxicity from Adriamycin. The data was demonstrated in older as well as younger patients from that trial. AC-T would ...
Would you finish neoadjuvant TC in a postmenopausal stage I TNBC patient who transferred care to your practice after 1 cycle or would you proceed with surgery and finish chemo adjuvantly?
Since I often administer TC x 4 in the adjuvant setting to patients with stage I TNBC, I would definitely be comfortable continuing this regimen in the neoadjuvant setting in such a patient. I use TC in these patients based on results from the ABC analysis (Blum et al, JCO 2017) which demonstrated a...
Why do we give four cycles of TC as adjuvant therapy when some of the clinical trials administered six cycles?
There are three trials I use to think about this issue: USOR 9735 (TC x 4 vs AC x 4, Jones et al JCO 2009; 27: 1177-1183), ECOG 1199 (AC x 4 with paclitaxel qw x 12, vs taxol q3w x 4, vs docetaxel qw x 12, vs docetaxel q3w x 4, Sparano et al JCO 2015; 33: 2353-2360) and the ABC analysis (TC x 6 vs T...
Would you consider age of 70 years as a contraindication (without any other cardiac risks) to use anthracycline in a triple negative breast cancer patient?
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What chemotherapy regimen would you recommend for high risk ER+/Her2- LN negative breast cancer with high genomic risk disease?
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