Epirubicin Plus Cyclophosphamide and Docetaxel Reduces Long-Term Risk of Recurrence for Patients With TOP2A Normal Early Breast Cancer

Final Results From the DBCG 07-READ Trial 

According to final results from the DBCG 07-READ trial, epirubicin plus cyclophosphamide and docetaxel (EC-D) reduced long-term risk of breast cancer recurrence compared to docetaxel and cyclophosphamide alone (DC) among patients with TOP2A normal early breast cancer. 

Between June 2008 and December 2012, researchers randomized 2012 patients with TOP2A normal node-positive or high-risk node-negative early breast cancer to receive either 3 cycles of EC-D (n = 1001) or 6 cycles of DC (n = 1011). At a median follow-up of 5 years, “there was no difference in the risk of disease-free survival (DFS; hazard ratio [HR], 1.00; P = 1.00) or overall survival (OS; HR, 1.15; P = .41),” stated Maj-Britt Jensen, MSc, Copenhagen University Hospital, Rigshospitalet, Denmark, and coauthors. Here, researchers report 10-year distant disease-free survival (DDFS), DFS, and toxicity results. 

With a median estimated potential follow-up of 10 years, patients in the EC-D arm experienced longer DDFS (adjusted HR, 0.79; 95% confidence interval [CI], 0.64 to 0.98; P = .03) and DFS (adjusted HR, 0.83; 95% CI, 0.69 to 0.99; P = .04) than those in the DC arm. There was no statistically significant difference in mortality between the treatment arms (HR, 0.88; 95% CI, 0.70 to 1.10; P = .25). Heart failure developed in 34 patients, including 23 in the EC-D arm and 11 patients in the DC arm with rates of 2.1% and 1.1%, respectively. During the follow-up window, heart failure led to death in 5 patients in the EC-D arm and 6 patients in the DC arm. 

“This final analysis of the READ trial demonstrated that EC-D significantly improves DDFS and in the adjusted analysis suggests an improvement of DFS,” concluded Dr Jensen et al. “After 10 years, the absolute risk of [heart failure] was increased by 1 percentage point following EC-D without increasing mortality from [heart failure].”

Despite these results, in an editorial accompanying this study, Thomas Grinda, MD, and Harold J. Burstein, MD, PhD, Dana-Farber Cancer Institute, Boston, Massachusetts, commented, “Incremental improvements in other treatment options and the use of biomarkers to define whether chemotherapy is indicated have diminished the chance that anthracyclines offer meaningful benefit to many patients with early stage breast cancer. The burning red devil of anthracycline-based care has clearly passed its zenith and begun a long goodbye.”

Source: 

Jensen MB, Balslev E, Knoop AS, et al. Adjuvant docetaxel and cyclophosphamide with or without epirubicin for early breast cancer: Final analysis of the randomized DBCG 07-READ trial. J Clin Oncol. Published online: October 23, 2024. doi: 10.1200/JCO.24.00836

Grinda T, and Burstein HJ. Anthracyclines in early breast cancer: The long goodbye. J Clin Oncol. Published online: November 5, 2024. doi:10.1200/JCO-24-01916