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Adjuvant taxane-based chemotherapy for early stage breast cancer: a real-world comparison of chemotherapy regimens in Ontario

  • Epidemiology
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Abstract

The purpose of this study was to compare survival and risk of adverse events in women with early stage breast cancer (BC) treated with (1) doxorubicin (A), cyclophosphamide (C) + paclitaxel (P), (2) fluorouracil (F), epirubicin (E), cyclophosphamide (C) + docetaxel (D), or (3) dose-dense AC-P. Retrospective cohort study including 8462 women aged ≥18 years, with resected stage I–III BC, diagnosed between 2003 and 2009 in Ontario, identified through linkage of administrative databases. Primary outcome is overall survival (OS). Secondary outcomes are emergency room (ER) visits/hospitalizations, heart failure (HF), and leukemia. 4710 women were treated with FEC-D, 2065 with AC-P, and 1687 with dd AC-P. Adjusted 5-year OS was 92.1, 87.7, and 90.3 %, for each regimen, respectively (p = 0.0006). There was no difference in OS for FEC-D and dd AC-P in the propensity score-matched analyses (HR 1.24, 95 % CI 0.99–1.55). Five-year risk of HF was also similar (HR 1.09; 0.66–1.791.4 % for dd AC-P and 1.3 % for FEC-D and, p = 0.72). Treatment with FEC-D was significantly associated with ER visits and hospital admissions (p < 0.0001). The risks of leukemia were low and similar among the 3 groups (AC-P: 0.34 %, FEC-D: 0.08 %, dd AC-P: 0.12 %; p = 0.09). Although the efficacy of the three regimens was similar to that observed in randomized trials, we report higher toxicity with the use of these regimens in clinical practice. This was especially concerning for the docetaxel-containing regimen.

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Acknowledgments

This study was supported through provision of data by the Institute for Clinical Evaluative Sciences (ICES) and Cancer Care Ontario (CCO) and through funding support to ICES from an annual grant by the Ministry of Health and Long-Term Care (MOHLTC) and the Ontario Institute for Cancer Research (OICR). The opinions, results, and conclusions reported in this paper are those of the authors and independent from the funding sources. No endorsement by ICES, CCO, OICR, or the Government of Ontario is intended or should be inferred.

Conflicts of interest

Sofia Torres has received honoraria from BMS, payment for travel, accommodations, or other expenses from BMS, Roche Farmaceutica Quimica, Celldex, and Astra-Zeneca and has received fellowship support from Genomic Health. Maureen Trudeau has stock or other ownership of RNA Diagnostics, has been a consultant or advisor for RNA Diagnostics, and has received honoraria from Roche, payment for travel, accommodations, or other expenses from Roche, and Dr. Trudeau’s institution has received research funding from Amgen, Astra-Zeneca, Novartis, Pfizer, RNA Diagnostics, Roche, Sanofi, Eisai, and Astellas. Andrea Eisen has received payment for travel, accommodations, and other expenses from Astra-Zeneca, and Dr. Eisen’s institution has received research funding from Genomic Health. Craig C. Earle and Kelvin KW Chan have no potential conflicts of interest for disclosure.

Ethical standard

This study received approval from the Sunnybrook Health Sciences Centre Research Ethics Board. This article does not contain any studies with human participants or animals performed by any of the authors.

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Authors and Affiliations

  1. Sunnybrook Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 023, T2 wing, Toronto, ON, M4N 3M5, Canada

    Sofia Torres, Maureen Trudeau, Andrea Eisen, Craig C. Earle & Kelvin K. W. Chan

  2. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Craig C. Earle

  3. Ontario Institute for Cancer Research, Toronto, ON, Canada

    Craig C. Earle

  4. University of Toronto, Toronto, ON, Canada

    Kelvin K. W. Chan

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  1. Sofia Torres
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Correspondence to Sofia Torres.

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Torres, S., Trudeau, M., Eisen, A. et al. Adjuvant taxane-based chemotherapy for early stage breast cancer: a real-world comparison of chemotherapy regimens in Ontario. Breast Cancer Res Treat 152, 137–145 (2015). https://doi.org/10.1007/s10549-015-3441-0

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