Results showed that after a median follow-up of 6.6 years and 297 events, 86% of patients who received EC-T were invasive disease-free at 5 years compared with 82% of those who received ET-X (HR=1.30; 95% CI: 1.03-1.64; P=0.03); however, overall survival was not statistically significantly different between the treatment arms (HR=1.13; 95% CI: 0.82-1.55; P=0.46).
In regard to safety, grade 3 or 4 neutropenia and myalgia were more common with EC-T, while grade 3 or 4 diarrhea and hand-foot syndrome occurred more frequently with ET-X (P<0.001). The rates of grade 3 or 4 febrile neutropenia, fatigue, mucositis, and vomiting were similar in both treatment arms.
Furthermore, 30% of patients who received EC-T reported incomplete scalp recovery compared with 14% of those who received ET-X (P<0.001). Patients who received EC-T also reported wearing wigs for a significantly longer duration than those who received ET-X (P<0.001).1
“The study shows that the standard sequent of EC followed by T is still the best option,” Dr. Martin said.
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Although the National Comprehensive Cancer Network (NCCN) Guidelines do not recommend EC-T as an adjuvant regimen for patients with HER2-negative invasive breast cancer, doxorubicin plus cyclophosphamide followed by paclitaxel or docetaxel (AC-T) are acceptable regimens.2 Because epirubicin is an analog of doxorubicin, “we can assume that AC-T and EC-T are very close to each other,” Dr. Martin said.
“This study reinforces the idea that the regimens EC-T and AC-T are still among the best adjuvant standards,” Dr. Martin concluded.
- Martin M, Simón AR, Borrego MR, et al. Epirubicin plus cyclophosphamide followed by docetaxel versus epirubicin plus docetaxel followed by capecitabine as adjuvant therapy for node-positive early breast cancer: results from the GEICAM/2003-10 study [published online ahead of print September 28, 2015]. J Clin Oncol. doi: 10.1200/JCO.2015.61.9510.
- National Comprehensive Cancer Network (NCCN) Guidelines for Breast Cancer. V 3.2015. Available at: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Updated July 16, 2015. Accessed October 2, 2015.