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).
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.
- 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.