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| |  DG DISPATCH - ATPBC: Dose-Dense Preoperative Chemotherapy Combination Is Favorable For Patients With Operable Breast Cancer By Maria Bishop Special to DG News
March 1, 2001 -- A dose-dense combination of adriamycin and docetaxel is as feasible, well tolerated and effective as a conventional sequence of chemotherapy when used as preoperative treatment in primary, operable breast cancer. At the 7th International Conference of Adjuvant Therapy for Primary Breast Cancer (ATPBC), in St. Gallen, Switzerland, Feb. 23, German researchers discussed an interim analysis revealing the highly effective nature of dose-dense combinations for preoperative chemotherapy for breast cancer, as part of the GEPARDO (German Preoperative Adriamycin Docetaxel) study. The research team, led by G. von Minckwitz, MD, of the University Women’s Hospital in Frankfurt/Main, Germany, undertook its eight-week study based on positive results from its own previous phase-II-b trial (Raab et al). The previous trial had demonstrated that certain dose-dense chemotherapy results in a pathologically complete response (pCR) rate of 9.9 percent. The chemotherapy used in that trial was ADOC, which comprises adriamycin (50 mg/m2) + docetaxel (75 mg/m2 every 14 days for four cycles) + G-CSF (granulocyte colony-stimulating factor-a substance that stimulates the production of neutrophils, a type of white blood cell) + tamoxifen. The randomized study under discussion demonstrated that this same dose-dense schedule can obtain a similar pCR rate as a conventional sequential schedule of AC-DOC. Conventional AC-DOC dosing is as follows: adriamycin (60 mg/m2) + cyclophosphamide (600 mg/m2 every 21 days for four cycles) followed by docetaxel (100 mg/m2 every 21 days for four cycles) prior to surgery. Tamoxifen (20 mg daily for five years) was given simultaneously in all patients, in both the ADOC and AC-DOC arms. Treatment groups (251 in the ADOC group and 251 in the AC-DOC group) were well balanced in terms of tumour characteristics. Median approximate tumour diameters were 4 cm and 2.9 cm, respectively. The median age was 53 years. In both groups, there were no recorded instances of grade 3 or 4 fluid retention or cardiac events. Thirteen patients in each group stopped therapy prematurely because of toxicity (14 patients), progression (five patients), death (one patient), other causes (two patients) or lack of compliance (four patients).
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