Docetaxel, doxorubicin, and cyclophosphamide (TAC) was not superior to doxorubicin and cyclophosphamide followed by docetaxel (AC→T) in the treatment of node-positive breast cancer, according to an article published in Annals of Oncology.1

In order to determine the optimal regimen for adjuvant breast cancer chemotherapy for women with node-positive non-metastatic breast cancer, investigators compared sequential to concurrent combination of doxorubicin and cyclophosphamide with docetaxel.

A total of 3298 women with HER2 non-amplified breast cancer were randomized to receive either doxorubicin and cyclophosphamide every 3 weeks for 4 cycles followed by AC→T every 3 weeks for 4 cycles or TAC every 3 weeks for 6 cycles. They also received standard radiotherapy and endocrine therapy and were followed for 10 years with annual clinical evaluation and mammography.

Results showed that the 10-year disease-free survival rates were 66.5% in the AC→T arm vs 66.3% in the TAC arm (P = .749). Overall survival was 79.9% in the AC→T arm vs 78.9% in the TAC arm (P = .506).

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In regard to safety, TAC was linked with higher rates of febrile neutropenia; however primary prophylaxis with granulocyte- colony stimulating factor significantly reduced the risk. AC→T was linked with a higher rate of myalgia, hand-foot syndrome, fluid retention, and sensory neuropathy.

The authors concluded that the TAC regimen with prophylactic support provided shorter adjuvant treatment duration with less toxicity.

Reference

  1. Mackey JR, Pieńkowski T, Crown J, et al. Long-term outcomes after adjuvant treatment of sequential versus combination docetaxel with doxorubicin and cyclophosphamide in node-positive breast cancer – BCIRG-005 randomized trial [published online ahead of print March 2, 2016]. Ann Oncol. doi: 10.1093/annonc/mdw098.