Scheduling of Chemotherapy and Survival
Posted 8/4/2011
Posted in
Treatments change all the time. What you are given depends very much on the moment of your diagnosis. Although most variables are rather small tweaks, the specifics can be different year to year. This can be be disconcerting to women who learn that a friend or colleague, with seemingly a similar diagnosis, is receiving a different treatment. There don't turn out to be great differences in survival among these variations, and all any of us can do is take the best available treatment when we need it.
This summary is abput a recent study comparing sequential AC, followed by T (taxol) vs ACT:
Oncology Article | Amenorrhea Breast Neoplasms Iatrogenic
Disease Survival
http://www.mdlinx.com/oncology/news-article.cfm/3175900/amenorrhea-breast-neoplasms-iatrogenic-diseasesurvival%
New England Journal of Medicine, 06/03/2010 Clinical Article
Swain SM et al. - Sequential ACT improved DFS as compared with doxorubicin-docetaxel or concurrent ACT, and it improved OS as compared with doxorubicin-docetaxel. Amenorrhea was associated with improved survival regardless of the treatment and estrogen-receptor status.
Methods
- Randomly assigned 5351 patients with operable, node-positive, early-stage breast cancer to receive 4 cycles of doxorubicin and cyclophosphamide followed by four cycles of docetaxel (sequential ACT); 4 cycles of doxorubicin and docetaxel (doxorubicin-docetaxel); or 4 cycles of doxorubicin, cyclophosphamide, and docetaxel (concurrent ACT)
- 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 concurrent-ACT regimen
- Secondary aims were to assess toxic effects and to correlate amenorrhea with outcomes in premenopausal women
Results - Median follow-up of 73 months, OS was improved in the sequential-ACT group (8-year OS, 83%) as compared with the doxorubicin-docetaxel group (OS, 79%; HR for death, 0.83; P=0.03) and the concurrent-ACT group (OR, 79%; HR, 0.86; P=0.09)
- DFS was improved in the sequential-ACT group (8-year DFS, 74%) as compared with the doxorubicin-docetaxel group (DFS, 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%; HR, 0.83; P=0.01)
- Doxorubicin-docetaxel regimen showed noninferiority to the concurrent-ACT regimen for OS (HR, 0.96; 95% confidence interval, 0.82 to 1.14)
- OS was improved in patients with amenorrhea for 6 months or more across all treatment groups, independently of estrogen-receptor status
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