Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2009-03-10
Docetaxel With Cyclophosphamide Is Associated With an Overall Survival Benefit Compared With Doxorubicin and Cyclophosphamide: 7-Year Follow-Up of US Oncology Research Trial 9735.
ABSTRACT
PURPOSE
We previously reported that four cycles of docetaxel/cyclophosphamide (TC) produced superior disease-free survival (DFS) compared with four cycles of doxorubicin/cyclophosphamide (AC) in early breast cancer. Older women are under-represented in adjuvant chemotherapy trials. In our trial 16% of patients were > or = 65 years. We now report 7-year results for DFS and overall survival (OS) as well as the impact of age, hormone receptor status, and HER2 status on outcome and toxicity.
PATIENTS AND METHODS
Patients were randomly assigned to receive either four cycles of standard-dose AC (60/600 mg/m(2); n = 510), or TC (75/600 mg/m(2); n = 506), administered by intravenous infusion every 3 weeks.
RESULTS
The median age in women younger than 65, was 50 years (range, 27 to 64) and for women > or = 65 was 69 years (range, 65 to 77). Baseline characteristics in the two age subgroups were generally well matched, except that older women tended to have more lymph node involvement. At a median of 7 years follow-up, the difference in DFS between TC and AC was significant (81% TC v 75% AC; P = .033; hazard ratio [HR], 0.74; 95% CI 0.56 to 0.98) as was OS (87% TC v 82% AC; P = .032; HR, 0.69; 95% CI, 0.50 to 0.97). TC was superior in older patients as well as younger patients. There was no interaction of hormone-receptor status or HER-2 status and treatment. Older women experienced more febrile neutropenia with TC and more anemia with AC.
CONCLUSION
With longer follow-up, four cycles of TC was superior to standard AC (DFS and OS) and was a tolerable regimen in both older and younger patients.
Related Questions
(For instance, TCX4 instead of AC->T for smaller tumors?)Does this affect your decision about treating with neoadjuvant versus adjuvant chemotherap...
New comment by Medical Oncologist at Forte, Schleider, Attas, and Condemi ( May 1, 2017)
interesting remark ,weighing long term toxicity with lasting good response
faforte
The ABC trials show a DFS advantage of anthracycline-based regimens. Would age alone procure you from using it in a patient?
New comment by Medical Oncologist at Warren Alpert Medical School of Brown University ( February 18, 2019)
I agree with @Gretchen G. Kimmick. It depends upon the patient's comorbid problems, especially any that would put her at increased risk for cardiac complications or limit her ...
I.e. according to Mammaprint test?
New comment by Medical Oncologist at Medical College of Wisconsin ( April 30, 2019)
Comment - For genomic risk assessment, I generally use the 21-gene assay for ER-positive, node-negative patients, and the 70-gene assay for node-positive (1-3 nodes) patients....
The ABC trials (Blum, JCO, 2017) used six cycles of TC. Is it because of the superiority seen with TC x four cycles versus standard AC x four cycles (...
New answer by Medical Oncologist at University of Pittsburgh School of Medicine (July 16, 2019)
There are three trials I use to think about this issue: USOR 9735 (TC x 4 vs AC x 4, Jones et al JCO 2009; 27: 1177-1183), ECOG 1199 (AC x 4 with paclitaxel qw x 12, vs taxol ...
If finished adjuvantly, what would you do -- continue TC or change chemotherapy?
New comment by Medical Oncologist at Colorado Permanente Medical Group Hematology & Oncology ( October 1, 2019)
Are you comfortable for TC x 4 vs TC x 6 in TNBC, even T1N0? ABC trial comparator was TC x 6. Is there concern that TC x 4 in aggressive biology breast cancer coul...
Does tumor size impact your recommendation? High grade? Young patient age?
New answer by Medical Oncologist at Private Practice and Digital Health (December 10, 2020)
Taxotere/Cytoxan (TC) 4 cycles would be a more reasonable standard adjuvant choice with proven DFS and OS advantage over AC (Jones et al, JCO 2009), and would avoid the risk o...