Lay it on thick.
Top Line: Dose-dense doxorubicin/cyclophosphamide followed by paclitaxel (AC → T) given every 2 weeks, instead of every 3-4 weeks, is the preferred regimen for most women receiving chemo for HER2(-) breast cancer.
The Study: That’s based on large randomized trials showing an improvement in survival, though there are also trials with more mixed results. For scenarios like this, EBCTCG meta-analyses are icing on the cake. Given their massive size, they often come many years after we kinda already know the questions they address. But their confirmation is still important. And here we get the 30,000 foot view, or rather the 30,000 patient view, of dose-dense chemo. Among all these patients and trials, we see a clear benefit to dose-dense regimens. This was most successfully accomplished by increasing the frequency of administration and by sequencing drugs whose doses aren’t easily intensified together (i.e. ddAC → ddT). The take-home points are that dose intensification resulted in a 3% absolute reduction in recurrence that translated to 2-3% absolute reductions in cancer-specific and all-cause mortality at 10 years. These findings were consistent across extent of disease and receptors status, including HER2(+) prior to the era of trastuzumab.
Bottom Line: Dose-dense chemo provides even more survival benefits than standard-dose chemo for women with breast cancer. | EBCTCG, Lancet 2019
The Study: That’s based on large randomized trials showing an improvement in survival, though there are also trials with more mixed results. For scenarios like this, EBCTCG meta-analyses are icing on the cake. Given their massive size, they often come many years after we kinda already know the questions they address. But their confirmation is still important. And here we get the 30,000 foot view, or rather the 30,000 patient view, of dose-dense chemo. Among all these patients and trials, we see a clear benefit to dose-dense regimens. This was most successfully accomplished by increasing the frequency of administration and by sequencing drugs whose doses aren’t easily intensified together (i.e. ddAC → ddT). The take-home points are that dose intensification resulted in a 3% absolute reduction in recurrence that translated to 2-3% absolute reductions in cancer-specific and all-cause mortality at 10 years. These findings were consistent across extent of disease and receptors status, including HER2(+) prior to the era of trastuzumab.
Bottom Line: Dose-dense chemo provides even more survival benefits than standard-dose chemo for women with breast cancer. | EBCTCG, Lancet 2019
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