Adjuvant Chemotherapy Regimens
This is an editorial from the Journal of Clinical Oncology which is rather dense, but important, reading. Looking at the efficacy of several adjuvant chemotherapy regimens, it concludes that two different ways of including a taxane in the treatment of node positive breast cancer are equally effective. Here is the beginning and a link:
The End of an Era: Shall We Move Forward?
Chau Dang, Memorial Sloan-Kettering Cancer Center, New York, NY
Systemic adjuvant chemotherapy is a critical means for eradicat- ing occult micrometastatic disease after surgery and has had a signifi- cant public health impact. The 2000 Early Breast Cancer Trialist' Collaborative Group overview of polychemotherapy in breast cancer demonstrated that anthracycline-based regimens were superior to nonanthracycline-based therapies with improved disease-free survival (DFS) and overall survival (OS).1-2 The next generation of random- ized clinical trials evaluated paclitaxel and docetaxel. These agents were well established in the treatment of metastatic breast cancer and lacked cross-resistance with the anthracyclines, which supported their evaluation in the adjuvant setting.3 Using these studies, a meta- analysis showed that the addition of a taxane to an anthracycline- based regimen improved DFS and OS in high-risk patients regardless of age, menopausal status, the number of nodes involved, hormone- receptor status, and the type of taxane.4 There are now several effective anthracycline-taxane combinations and anthracycline-based regi- mens used in patients with high-risk disease. These include dose- dense (dd) doxorubicin (A) plus cyclophosphamide (C) 3 by dd paclitaxel, AC 3 weekly paclitaxel, AC 3 docetaxel, docetaxel plus AC (TAC), A 3 docetaxel 3 C plus methotrexate and fluorouracil (F; CMF), F plus epirubicin (E) and C (FEC) 3 docetaxel, FEC 3 weekly paclitaxel, EC 3 docetaxel, CEF, and E 3 CMF.5-15