Adjuvant docetaxel, doxorubicin, and cyclophosphamide in node-positive breast cancer: 10-year follow-up of the phase 3 randomised BCIRG 001 trial

Cross Cancer Institute, Edmonton, AB, Canada.
The Lancet Oncology (Impact Factor: 24.69). 12/2012; 14(1). DOI: 10.1016/S1470-2045(12)70525-9
Source: PubMed


BACKGROUND: We compared standard adjuvant anthracycline chemotherapy with anthracycline-taxane combination chemotherapy in women with operable node-positive breast cancer. Here we report the final, 10-year follow-up analysis of disease-free survival, overall survival, and long-term safety. METHODS: BCIRG 001 was an open label, phase 3, multicentre trial in which 1491 patients aged 18-70 years with node-positive, early breast cancer and a Karnofsky score of 80% or more were randomly assigned to adjuvant treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC) or fluorouracil, doxorubicin, and cyclophosphamide (FAC) every 3 weeks for six cycles. Randomisation was stratified according to institution and number of involved axillary lymph nodes per patient (one to three vs four or more). Disease-free survival was the primary endpoint and was defined as the interval between randomisation and breast cancer relapse, second primary cancer, or death, whichever occurred first. Efficacy analyses were based on the intention-to-treat principle. BCIRG 001 is registered with, number NCT00688740. FINDINGS: Enrolement took place between June 11, 1997 and June 3, 1999; 745 patients were assigned to receive TAC and 746 patients were assigned to receive FAC. After a median follow-up of 124 months (IQR 90-126), disease-free survival was 62% (95% CI 58-65) for patients in the TAC group and 55% (51-59) for patients in the FAC group (hazard ratio [HR] 0·80, 95% CI 0·68-0·93; log-rank p=0·0043). 10-year overall survival was 76% (95% CI 72-79) for patients in the TAC group and 69% (65-72) for patients in the FAC group (HR 0·74, 0·61-0·90; log-rank p=0·0020). TAC improved disease-free survival relative to FAC irrespective of nodal, hormone receptor, and HER2 status, although not all differences were significant in these subgroup analyses. Grade 3-4 heart failure occurred in 26 (3%) patients in the TAC group and 17 (2%) patients in the FAC group, and caused death in two patients in the TAC group and four patients in the FAC group. A substantial decrease in left ventricular ejection fraction (defined as a relative decrease from baseline of 20% or more) was seen in 58 (17%) patients who received TAC and 41 (15%) patients who received FAC. Six patients who received TAC developed leukaemia or myelodysplasia, as did three patients who received FAC. INTERPRETATION: Our results provide evidence that the initial therapeutic outcomes seen at the 5-year follow-up with a docetaxel-containing adjuvant regimen are maintained at 10 years. However, a substantial percentage of patients had a decrease in left ventricular ejection fraction, probably caused by anthracycline therapy, which warrants further investigation. FUNDING: Sanofi.

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    • "Clinical trials have strict and mandatory diagnostic, management and follow-up protocols. They generate Disease-Free Survival (DFS) and Overall Survival (OS) data at 3 or 5 years with some updates at 8 or 10 years,3-5 and provide evidence-based results that are used for clinical practice guidelines. Meta-analyses combine data from clinical trials and present further conclusions on mortality and survival data at 5, 10, 15 years, or even longer.6 "
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    • "As a result, anthracycline- and taxane-based chemotherapeutic regimens have become the standard of care in early stage breast cancers. Among the most active adjuvant chemotherapy regimens, the docetaxel-based combinations of docetaxel, doxorubicin, and cyclophosphamide (TAC),6–8 docetaxel with cyclophosphamide,9,10 sequential anthracycline (eg, FEC [5-fluorouracil, epirubicin, and cyclophosphamide]) followed by docetaxel monotherapy,11–14 and docetaxel, carboplatin, and trastuzumab15 are most commonly used. "
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    • "The present study was primarily initiated to evaluate the cardiac safety of bevacizumab when given in combination with a standard-of-care anthracycline-based treatment—docetaxel, doxorubicin, cyclophosphamide (TAC) (Mackey et al. 2013)—in the adjuvant setting. At the time of study initiation, larger studies, such as Eastern Cooperative Oncology Group (ECOG) E5103 (National Cancer Institute), were being planned to evaluate bevacizumab in adjuvant, HER2-negative breast cancer patients. "
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