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Neoadjuvant therapy with doxorubicin-cyclophosphamide followed by weekly paclitaxel in early breast cancer: a retrospective analysis of 200 consecutive patients treated in a single center with a median follow-up of 9.5 years

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Abstract

Purpose

We analyzed outcomes of doxorubicin-cyclophosphamide (AC) followed by weekly paclitaxel as neoadjuvant chemotherapy (NAC) for breast cancer (BC), in an everyday practice with long-term follow-up of patients.

Methods

All patients (n = 200) who received the AC-paclitaxel combination as NAC for BC at the Soroka University Medical Center from 2003 to 2012 were included in this retrospective cohort study. AC was administered on an every 3-week schedule (standard dose) until May, 2007 (n = 99); and subsequently every 2-week dose dense (dd) (n = 101). Clinical pathologic features, treatment course, and outcome information were recorded. Complete pathologic response (pCR) was analyzed according to BC subtype, dose regimen, and stage.

Results

Median age was 49 years; 55.5% and 44.5% of patients were clinically stage 2 and 3, respectively. Standard dose patients had more T3 tumors. Subtypes were human epidermal growth factor receptor-2 (HER2)-positive 32.5% (of whom 82% received trastuzumab), hormone receptor-positive/HER2-negative 53%, and triple negative 14.5%. Breast-conserving surgery (BCS) was performed in 48.5% of patients; only 9.5% were deemed suitable for BCS prior to NAC. Toxicity was acceptable. The overall pCR rate was 26.0% and was significantly higher in the dd group and HER2-positive patients. With a median follow-up of 9.51 years median event-free survival (EFS) and overall survival (OS) are 10.85 years and 12.61 years, respectively. Patients achieving pCR had significantly longer EFS and OS.

Conclusion

NAC for BC with AC-paclitaxel can be safely administered in the “real-world’ setting with high efficacy. Current efforts are aimed at increasing rates of pCR and identifying patients who may benefit from additional therapy or conversely, de-escalated treatment.

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Data availability

The data analyzed in this study are available on reasonable request from the corresponding author.

Code availability

Not applicable.

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Acknowledgements

This paper is dedicated to the memory of Simeon Szerinski, M.D. who as radiologist at the Soroka Medical Center’s Eshkol Breast Center performed most of the initial mammographic examinationss, ultrasounds, and biopsies of the patients described in this analysis. He was much beloved by patients and colleagues for his skill and compassion. Preliminary unpublished versions of this study were conducted as part of the requirements for the degree of Doctor of Medicine for Tamar Hertz Mizrahi and Lisi M. Dredze at the Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. Preliminary findings of this study were presented orally at the 6th and 16th annual meetings of the Israel Society of Clinical Oncology and Radiotherapy in 2007 and 2017, respectively, and as a poster presentation at the EBCC7-European Breast Cancer Conference in Barcelona in 2010.

Funding

LMD received a medical student summer research grant from the Israel Cancer Association to work on this project. No other funding.

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Authors and Affiliations

  1. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

    Lisi M. Dredze, Michael Friger, Samuel Ariad, Michael Koretz, Bertha Delgado, Ruthy Shaco-Levy, Margarita Tokar, Michael Bayme, Ravit Agassi, Maia Rosenthal, Victor Dyomin, Olga Belochitski, Shai Libson, Tamar Mizrahi & David B. Geffen

  2. Department of Oncology, Soroka University Medical Center, Beer Sheva, Israel

    Lisi M. Dredze, Samuel Ariad, Margarita Tokar, Olga Belochitski, Tamar Mizrahi & David B. Geffen

  3. Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel

    Michael Friger

  4. Division of Surgery and The Eshkol Breast Center, Soroka Medical Center, Beer Sheva, Israel

    Michael Koretz, Michael Bayme, Ravit Agassi & Shai Libson

  5. Department of Pathology, Soroka University Medical Center, Beer Sheva, Israel

    Bertha Delgado, Ruthy Shaco-Levy & Victor Dyomin

  6. Department of Imaging and The Eshkol Breast Center, Soroka Medical Center, Beer Sheva, Israel

    Maia Rosenthal

Authors
  1. Lisi M. Dredze
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  2. Michael Friger
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  15. David B. Geffen
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Contributions

LMD, MF, TM, and DBG designed the analysis. SA, MK, MT, MB, RA, OB, SL, and DBG cared for the patients. MF performed the statistical analysis. BD, RSL, and VD performed the pathologic analyses. MR interpreted many of the follow-up breast imaging studies and performed biopsies on many of the patients with breast recurrences. LMD, MT, OB, TM, and DBG gathered the data. All of the authors participated in writing the manuscript and have approved it.

Corresponding author

Correspondence to David B. Geffen.

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None of the authors have any conflicts of interest or competing interests to report.

Ethical approval

This study was approved by the Soroka University Medical Center Institutional Review Board (IRB).

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Requirement for patient consent waived by the IRB, because of the retrospective nature of the study and the anonymization of patient data.

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Requirement for patient consent for publication waived by the IRB, because of the retrospective nature of the study and the anonymization of patient data.

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Dredze, L.M., Friger, M., Ariad, S. et al. Neoadjuvant therapy with doxorubicin-cyclophosphamide followed by weekly paclitaxel in early breast cancer: a retrospective analysis of 200 consecutive patients treated in a single center with a median follow-up of 9.5 years. Breast Cancer Res Treat 193, 597–612 (2022). https://doi.org/10.1007/s10549-022-06598-0

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