DOSE AND DOSE INTENSITY OF ADJUVANT CHEMOTHERAPY FOR STAGE-II, NODE-POSITIVE BREAST-CARCINOMA

Background. Adjuvant chemotherapy is widely used for breast cancer and is known to extend survival. Some clinicians seek a greater survival benefit by increasing the intensity of the dose, whereas others lower it to diminish toxicity.Methods. The Cancer and Leukemia Group B (CALG B) conducted a randomized trial of different levels of doses and dose intensity (dose per unit of time) of adjuvant chemotherapy in 1572 wom en with node-positive, stage II breast cancer who were assigned to thr ee treatment groups. One group received 400 mg of cyclophosphamide per square meter of body-surface area and 40 mg of doxorubicin per square meter once every 28 days and 400 mg of fluorouracil per square meter twice every 28 days, for six cycles. Another group received 50 percent higher doses of the three drugs (600 mg, 60 mg, and 600 mg, respectiv ely) but for only four cycles, so that the total dose was identical in these two groups but the dose intensity was higher in the second. The third group of women received half the total dose used in the other t wo groups and at half the dose intensity used in the second group. Res ults. After a median of 3.4 years of follow-up, the women treated with a high or moderate dose intensity had significantly longer disease-fr ee survival (P<0.001) and overall survival (P = 0.004) than those trea ted with a low dose intensity, in three-way log-rank comparisons. Howe ver, the difference in survival between the two groups treated with a moderate or high dose intensity was not significant. These results are consistent with either a dose-response effect or a threshold level of the dose or dose intensity. Conclusions. The doses of chemotherapy us ed to treat breast cancer, especially early breast cancer, should not be reduced if the maximal benefit is to be achieved.