Phase II study of docetaxel, doxorubicin, and cyclophosphamide as first-line chemotherapy for metastatic breast cancer

Purpose: This pilot phase II study investigated the efficacy and toxicity o f docetaxel with doxorubicin and cyclophosphamide (TAC) as first-line chemo therapy for anthracycline-naive patients with metastatic breast cancer. Patients and Methods: Fifty-four patients received a total of 359 courses c onsisting of docetaxel 75 mg/m(2) given intravenously (IV) over 1 hour, pre ceded by IV doxorubicin 50 mg/m(2) and cyclophosphamide 500 mg/m2 for a max imum of eight 3-week cycles. Results: After an independent panel review, the overall objective response rate was 77% (complete response, 6%), Overall objective response rates in p atients with visceral, bone, and liver involvement were 82%, 82%, and 80%, respectively. Median duration of response was 52 weeks, and median time to progression was 42 weeks. With a median follow-up of 32 months, the median survival had not yet been reached, whereas the 2-year survival was 57%. The main toxicities were hematologic (neutropenia grade 3/4 in 100% of patient s and 95% of cycles; febrile neutropenia in 34% of patients and 9% of cycle s). Documented grade 3 infection wets seen in one patient (2%) in one cycle , and no toxic death was reported. Severe acute or chronic nonhematologic a dverse events were infrequent, and docetaxel-specific toxicities (such as f luid retention and nail changes) were mild, with only one patient being dis continued for fluid retention. Congestive heart failure was seen in two pat ients (4%). Conclusion: TAC is an active and manageable regimen that has been chosen as the basis of five randomized phase III trials, including two pivotal studi es comparing TAC to fluorouracil plus doxorubicin and cyclophosphamide in t he metastatic and adjuvant treatment of breast cancer. J Clin Oncol 19:314- 321, (C) 2001 by American Society of Clinical Oncology.