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Breast Cancer • Medical Oncology
When, if ever, do you consider administering weekly paclitaxel prior to dose dense AC for neoadjuvant treatment of breast cancer?
I have seen some advocate for this in the community, although a Cochrane metanalysis did not find an advantage to giving the taxane earlier.
Answer from: Medical Oncologist at Community Practice
There are data that the sequence of initiating neoadjuvant chemotherapy with a taxane prior to an anthracycline may result in greater reduction of circulating breast cancer cells (Pachmann 2004 - page S224). In the small randomized NeoSAMBA trial, T-FAC had improved clinical outcomes, such as DFS, c...
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Answer from: Medical Oncologist at Academic Institution
In HER2-negative disease, I routinely administer the taxane first, followed by AC in the neoadjuvant setting. As others have pointed out, there are no strong data suggesting that long-term outcomes (DFS or OS) are different with either sequence. However, the Neo-tAnGo study suggested improved pCR ra...
Answer from: Medical Oncologist at Community Practice
I have reversed the order in the neoadjuvant setting if clinically I was more worried about AC toxicity and want to see how much I can get from weekly taxol. An older, frail patient with unoperated on triple negative disease, significant comorbodities, risk of caxiotoxicities otherwise, would make m...