Hi, folks. If you haven't started chemo yet, and are choosing between TAC (all drugs at same time) and ACT (first AC then Taxane), this article suggests that ACT might be better.
Longer Therapy, Iatrogenic
Amenorrhea, and Survival in Early Breast Cancer
N Engl J Med.
2010 Jun 3;362(22):2122-2124, SM Swain, JH Jeong, CE Geyer Jr, JP
Costantino, ER Pajon, L Fehrenbacher, JN Atkins, J Polikoff, VG Vogel,
JK Erban, P Rastogi, RB Livingston, EA Perez, EP Mamounas, SR Land, PA
Ganz, N Wolmark
ABSTRACT
In this study that enrolled more than
5000 women with early-stage, node-positive, operable breast cancer,
chemotherapy with sequential-ACT improved both DFS and OS when compared
with four cycles of doxorubicin/docetaxel...
Background:
Chemotherapy regimens that combine anthracyclines and taxanes result in
improved disease-free and overall survival among women with operable
lymph-node-positive breast cancer. The effectiveness of concurrent
versus sequential regimens is not known.
Methods: We randomly
assigned 5351 patients with operable, node-positive, early-stage breast
cancer to receive four cycles of doxorubicin and cyclophosphamide
followed by four cycles of docetaxel (sequential ACT); four cycles of
doxorubicin and docetaxel (doxorubicin-docetaxel); or four cycles of
doxorubicin, cyclophosphamide, and docetaxel (concurrent ACT). The
primary aims were to examine whether concurrent ACT was more effective
than sequential ACT and whether the doxorubicin-docetaxel regimen would
be as effective as the concurrent-ACT regimen. The secondary aims were
to assess toxic effects and to correlate amenorrhea with outcomes in
premenopausal women.
Results: At a median follow-up of 73 months,
overall survival was improved in the sequential-ACT group (8-year
overall survival, 83%) as compared with the doxorubicin-docetaxel group
(overall survival, 79%; hazard ratio for death, 0.83; P=0.03) and the
concurrent-ACT group (overall survival, 79%; hazard ratio, 0.86;
P=0.09). Disease-free survival was improved in the sequential-ACT group
(8-year disease-free survival, 74%) as compared with the
doxorubicin-docetaxel group (disease-free survival, 69%; hazard ratio
for recurrence, a second malignant condition, or death, 0.80; P=0.001)
and the concurrent-ACT group (disease-free survival, 69%; hazard ratio,
0.83; P=0.01). The doxorubicin-docetaxel regimen showed noninferiority
to the concurrent-ACT regimen for overall survival (hazard ratio, 0.96;
95% confidence interval, 0.82 to 1.14). Overall survival was improved in
patients with amenorrhea for 6 months or more across all treatment
groups, independently of estrogen-receptor status.
Conclusion:
Sequential ACT improved disease-free survival as compared with
doxorubicin-docetaxel or concurrent ACT, and it improved overall
survival as compared with doxorubicin-docetaxel. Amenorrhea was
associated with improved survival regardless of the treatment and
estrogen-receptor status.
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DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.
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