A. Di Leo et al., A feasibility study evaluating docetaxel-based sequential and combination regimens in the adjuvant therapy of node-positive breast cancer, ANN ONCOL, 11(2), 2000, pp. 169-175
Background and purpose: Docetaxel is an active agent in the treatment of me
tastatic breast cancer. We evaluated the feasibility of docetaxel-based seq
uential and combination regimens as adjuvant therapies for patients with no
de-positive breast cancer.
Patients and methods: Three consecutive groups of patients with node-positi
ve breast cancer or locally-advanced disease, aged less than or equal to 70
years, received one of the following regimens: a) sequential A --> T --> C
MF: doxorubicin 75 mg/m(2) q 3 weeks x 3, followed by docetaxel 100 mg/m(2)
q 3 weeks x 3, followed by i.v. CMF days 1 + 8 q 4 weeks x 3; b) sequentia
l accelerated A --> T --> CMF: A and T were administered at the same doses
q 2 weeks; c) combination therapy: doxorubicin 50 mg/m(2) + docetaxel 75 mg
/m(2) q 3 weeks x 4, followed by CMF x 4. When indicated, radiotherapy was
administered during or after CMF, and tamoxifen started after the end of CM
F.
Results: Seventy-nine patients have been treated. Median age was 48 years.
A 30% rate of early treatment discontinuation was observed in patients rece
iving the sequential accelerated therapy (23% during A --> T), due principa
lly to severe skin toxicity. Median relative dose-intensity was 100% in the
three treatment arms. The incidence of G3-G4 major toxicities by treated p
atients, was as follows: skin toxicity a: 5%; b: 27%; c: 0%; stomatitis a:
20%; b: 20%; c: 3%. The incidence of neutropenic fever was a: 30%; b: 13%;
c: 48%. After a median follow-up of 18 months, no late toxicity has been re
ported.
Conclusions: The accelerated sequential A --> T --> CMF treatment is not fe
asible due to an excess of skin toxicity. The sequential non accelerated an
d the combination regimens are feasible and under evaluation in a phase III
trial of adjuvant therapy.