Adjuvant sequential dose-dense doxorubicin, paclitaxel, and cyclophosphamide (ATC) for high-risk breast cancer is feasible in the community setting

PURPOSE This study evaluated the feasibility, when given in the community, of dose- dense, sequential ATC (doxorubicin, paclitaxel, cyclophosphamide) as adjuva nt therapy for breast cancer with four or more metastatic axillary lymph no des. PATIENTS AND METHODS Patients were recruited after definitive breast cancer surgery if four or m ore axillary nodes were involved by metastatic cancer and if distant metast ases were not present on computed tomographic scan or bone scan. Ferry pati ents received doxorubicin, 90 mg/m(2) every 14 days for three cycles; pacli taxel, 250 mg/m(2) every 14 days for three cycles; and cyclophosphamide, 3 g/m(2) every 14 days for three cycles with filgrastim support. Chemotherapy was administered by the referring physician. RESULTS Mean dose intensity mas 99% for doxorubicin, 96% for paclitaxel, and 99% fo r cyclophosphamide. Grade 3 toxicities included mucositis (13%), nausea/vom iting (10%), neuropathy (13%), and myalgia/arthralgia (10%). Thirteen patie nts had neutropenic fever. One patient developed acute leukemia. Three rela pses have occurred. Ninety percent of patients are alive and disease-free a t a median follow-up of 24 months. DISCUSSION ATC can be administered in the community at full doses with acceptable toxi city. Preliminary efficacy data suggest that this high-dose, intensively sc heduled regimen warrants comparison with standard therapy for high-risk pat ients.