Sequential AC-T Is Superior Adjuvant Therapy for Early Stage Breast Cancer

A systematic review and meta-analysis showed that sequential anthracycline cyclophosphamide and taxane (AC-T) was likely to be the most effective adjuvant therapy for patients with early stage breast cancer, regardless of their hormone receptor status.¹

Investigators attempted to identify the most effective adjuvant therapy regimen. They searched MEDLINE, Embase, and the Cochrane Library for articles published prior to June 15, 2015; the American Society of Clinical Oncology annual meeting abstracts from January 1983 to December 2014; and the American Association for Cancer research annual meeting abstracts from January 1916 to December 2014.

Investigators included randomized clinical trials of adjuvant treatments for early stage breast cancer that compared 2 or more of the following: no adjuvant chemotherapy; sequential anthracycline-cyclophosphamide and taxane (AC-T); concurrent anthracycline-cyclophosphamide and taxane (ACT); anthracycline-cyclophosphamide without taxane (AC); docetaxel and cyclophosphamide (TC); cyclophosphamide, methotrexate, and fluorouracil (CMF); and platinum-containing regimens.

Network meta-analysis was used to test the most effective adjuvant therapy regimen in terms of overall survival (OS) by comparing regimens listed in the National Comprehensive Cancer Network guidelines and platinum-containing regimens.

Out of the 24 trials identified, TC and platinum-containing regimens had OS benefit similar to that of sequential AC-T (TC hazard ratio [HR], 0.93; 95% CI: 0.62-1.40; and platinum HR, 0.93; 95% CI: 0.66-1.31).

Patients treated with CMF or AC had significantly worse OS than those treated with sequential AC-T (CMF HR, 1.56; 95% CI: 1.32-1.85; and AC HR, 1.22; 95% CI: 1.10-1.37). Platinum-containing regimens tended to be more toxic than sequential AC-T. The toxicity of TC was similar to or less than that of sequential AC-T.

Reference

1. Fujii T, Le Du F, Xiao L, et al. Effectiveness of an adjuvant chemotherapy regimen for early-stage breast cancer. [published online ahead of print September 24, 2015]. JAMA Oncol. doi: 10.1001/jamaoncol.2015.3062.