Impact of sequencing weekly paclitaxel (T) and dose-dense doxorubicin/cyclophosphamide (DDAC) on tolerability and relative dose intensity (RDI) in breast cancer (BC) patients (pts) receiving neoadjuvant chemotherapy (NAC).
2015; Lippincott Williams & Wilkins; Volume: 33; Issue: 15_suppl Linguagem: Inglês
10.1200/jco.2015.33.15_suppl.1048
ISSN1527-7755
AutoresNicholas LeCroy, Irene Borrero, Dina Bernie Dumercy, Evelio Velis, Alejandra Perez, Michel Velez, Aruna Mani, Aurelio Castrellon, Carla Hawkins Locke, Cynthia Frankel, Candice Sareli, Carmen Calfa,
Tópico(s)Cancer Genomics and Diagnostics
Resumo1048 Background: A preferred NAC regimen for HER2-negative BC is DDAC for 4 cycles followed by 12 weeks of T. RDI of 1 indicates that all intended doses are given at the scheduled interval. While large randomized studies are lacking, few studies indicated improved pCR and/or RDI when taxanes are given first. We hypothesize that tolerability and RDI are improved when T is given before DDAC. To our knowledge, this is the first study evaluating the impact of sequence on tolerability and RDI when using DDAC/weekly T. Methods: This IRB-approved, retrospective chart review included pts with stage II-III HER2-negative BC who received DDAC/weekly T NAC at our institution between August 2012 and May 2014. The sequence was based on physician preference. Conventional sequence group (CS) included pts who received weekly T after DDAC; reverse sequence group (RS) received T before DDAC. Our primary outcomes were rate of pCR and tolerability/RDI. Results: We identified 27 pts in CS and 29 pts in RS. No statistical differences between groups with respect to age, ethnicity or tumor characteristics (ER, PR, Ki67) were found. The RS had numerically more pts with stage III (p = 0.054). The table lists results relevant to the primary objectives. Conclusions: T before DDAC was associated with more pts tolerating the T maximum dose intensity (T-RDI = 1) without compromising DDAC-RDI or pCR. More pts experienced a T dose reduction (T-DR) in CS. The difference in tolerability of T cannot be explained by a specific toxicity but rather by a multitude of complications observed in CS. The most common reason for decreased T-RDI was peripheral neuropathy (PN) in both groups. Interestingly, significantly more pts in CS required pharmacologic intervention (Rx) for PN. Our study confirms the findings of others with respect to administering taxanes before antracyclines and provides specific evidence to support sequencing weekly T before DDAC. Outcome, # (%) CS (N = 27) RS (N = 29) p T-RDI = 1 11 (40.7) 20 (69) 0.034 DDAC-RDI = 1 22 (81.5) 21 (72.4) 0.422 T-DR 11 (40.7) 5 (17.2) 0.049 pCR 5 (18.5) 5 (17.2) 0.587 Rx for PN 16 (59.3) 9 (31) 0.034
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