Selection of adjuvant chemotherapy for treatment of node-positive breast cancer

• Published in: The lancet oncology 2005-11, Vol.6 (11), p.886-898
• Main Authors: Trudeau, Maureen, Charbonneau, Flay, Gelmon, Karen, Laing, Kara, Latreille, Jean, Mackey, John, McLeod, Deanna, Pritchard, Kathy, Provencher, Louise, Verma, Shailendra
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Chemotherapy, Adjuvant - methods; Cyclophosphamide - adverse effects; Cyclophosphamide - therapeutic use; Disease-Free Survival; Doxorubicin - adverse effects; Doxorubicin - therapeutic use; Epirubicin - adverse effects; Epirubicin - therapeutic use; Female; Fluorouracil - adverse effects; Fluorouracil - therapeutic use; Humans; Methotrexate - adverse effects; Methotrexate - therapeutic use; Middle Aged; Randomized Controlled Trials as Topic; Taxoids - adverse effects; Taxoids - therapeutic use
• ISSN: 1470-2045; 1474-5488
• DOI: 10.1016/S1470-2045(05)70424-1

Over the past two decades, several studies have suggested that regimens that contain anthracyclines are more effective than those that do not. A meta-analysis by the 2005 Early Breast Cancer Trialists' Collaborative Group confirmed that about 6 months of anthracycline-based polychemotherapy in the adjuvant setting reduced the yearly death rate from breast cancer by about 38% for women younger than 50 years and by 20% for women aged 50–69 years. Although this meta-analysis found that survival was better with regimens that contain anthracycline than with regimens based on cyclophosphamide, methotrexate, and fluorouracil, the best use of anthracycline-based regimens remains unclear. Adjuvant regimens in use can be categorised into three groups: standard-dose anthracycline; escalated-dose epirubicin; and anthracyclines and taxanes. The duration of treatment and combination of dose and drugs varies between these three categories. We reviewed the three types of regimen to establish which provide a better outcome in terms of safety, efficacy, cost, and convenience to patients. We found that both escalated-dose epirubicin and anthracycline–taxane regimens were most effective in terms of disease-free survival and overall survival. Of the specific anthracycline-based regimens, the docetaxel, doxorubicin, and cyclophosphamide regimen (TAC); the fluorouracil, 100 mg epirubicin, and cyclophosphamide regimen (FEC100); and the cyclophosphamide, epirubicin, and fluorouracil regimen (CEF) produced the greatest proportional decreases in 5-year death rate.