The use of tailored dose-dense chemotherapy compared with standard adjuvant chemotherapy does not result in significant improvement in high-risk early breast cancer recurrence-free survival (RFS), according to a study published in JAMA.
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Dose-dense therapy, or chemotherapy delivered in shorter intervals than standard chemotherapy without increasing the cumulative dose, has been shown to improve the efficacy of chemotherapy for patients with early breast cancer.
To determine whether tailored dose-dense adjuvant chemotherapy improves RFS of early breast cancer compared with a standard 3-weekly chemotherapy schedule, a group of doctors led by Jonas Bergh, MD, professor and senior physician in the department of oncology-pathology at Cancer Center Karolinska of Karolinska Institute and University Hospital in Stockholm, tested 2017 women younger than 65 years who had surgery for nonmetastatic node-positive or high-risk, node-negative breast cancer. Patients were randomly assigned to receive tailored dose-dense adjuvant chemotherapy (n = 1006) or standard 3-weekly chemotherapy (n = 1011).
After a median follow-up of 5.3 years, researchers found that there was no significant difference in RFS in either of the two study cohorts. RFS events occurred in 118 women in the tailored dose-dense group and 151 women in the standard-interval group. The average 5-year breast cancer RFS rate was 88.7% in the tailored dose-dense group, as compared to 85% in the standard-interval group.
However, the tailored dose-dense group did have a significantly better 5-year event-free survival rate than the standard-interval group (86.7% vs. 82.1%, respectively).
Results of the study also indicated nonhematological toxic effects occurred significantly more frequently in the tailored dose-dense group than in the standard-interval group (52.6% vs. 36.6 %, respectively). Toxic effects included fatigue, musculoskeletal pain, and neutropenic infection.
“Although the total treatment time was similar, patients in the tailored dose-dense group underwent more therapy courses and subsequently had more toxic effects, more hospital visits and frequent blood draws,” concluded Dr Bergh.
