Dose-dense paclitaxel versus docetaxel following FEC as adjuvant chemotherapy in axillary node-positive early breast cancer: a multicenter randomized study of the Hellenic Oncology Research Group (HORG)
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Adding a taxane to anthracycline-based adjuvant chemotherapy prolongs survival in node-positive early breast cancer. However, which is the preferable taxane in a dose-dense regimen remains unknown. We conducted a randomized study to compare the efficacy of dose-dense paclitaxel versus docetaxel following 5-fluorouracil, epirubicin, and cyclophosphamide (FEC) as adjuvant chemotherapy in women with node-positive early breast cancer. Following surgery women with HER2-negative breast cancer and at least one infiltrated axillary lymph node were randomized to receive four cycles of FEC (700/75/700 mg/m2) followed by four cycles of either paclitaxel (175 mg/m2) or docetaxel (75 mg/m2). All cycles were administered every 14 days with G-CSF support. The primary endpoint was disease-free survival (DFS) at 3 years. Between 2004 and 2007, 481 women were randomized to paclitaxel (n = 241) and docetaxel (n = 240). After a median follow-up of 6 years, 51 (21 %) and 48 (20 %) women experienced disease relapse (p = 0.753) and there was no significant difference in DFS between the paclitaxel- and docetaxel-treated groups (3-year DFS 87.4 vs. 88.3 %, respectively; median DFS not reached; p = 0.633). Toxicities were manageable, with grade 2–4 neutropenia in 21 versus 31 % (p = 0.01), thrombocytopenia 0.8 versus 3.4 % (p = 0.06), any grade neurotoxicity 17 versus 7.5 % (p = 0.35) and onycholysis 4.9 versus 12.1 % (p = 0.03) for patients receiving paclitaxel and docetaxel, respectively. There were no toxic deaths. Dose-dense paclitaxel versus docetaxel after FEC as adjuvant chemotherapy results in a similar 3-year DFS rate in women with axillary node-positive early breast cancer. Due to its more favorable toxicity profile, paclitaxel is the taxane of choice in this setting.
KeywordsPaclitaxel Docetaxel Taxanes Dose-dense Adjuvant chemotherapy Breast cancer
We acknowledge the assistance of Dora Hatzidaki and Vasso Athanasaki in the preparation of this manuscript.
Conflict of interest
The authors have declared no pertinent conflicts of interest.
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