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.

Continue Reading

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.

RELATED: GnRH Agonists With Chemo for Breast Cancer May Restore Regular Menses

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.


  1. 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.
  2. National Comprehensive Cancer Network (NCCN) Guidelines for Breast Cancer. V 3.2015. Available at: Updated July 16, 2015. Accessed October 2, 2015.