High-Risk, Early-Stage Breast Cancer: Tailored Dose-Dense vs Standard Adjuvant Chemotherapy

By: Julia Cipriano, MS
Posted: Monday, August 26, 2024

Patients with high-risk, early-stage breast cancer derived significant breast cancer recurrence–free, event-free, and distant disease–free survival benefits from tailored dose-dense vs standard adjuvant chemotherapy, based on the end-of-study results of the international phase III PANTHER trial published in the Journal of Clinical Oncology. According to Alexios Matikas, MD, PhD, of Karolinska Institutet, Stockholm, and colleagues, dose-dense schedules appear to maintain superiority irrespective of comparator treatment.

“Observed improvements [with dose-dense adjuvant chemotherapy every 2 weeks] are largely limited to studies using the suboptimal paclitaxel schedule every 3 weeks as a control,” the investigators commented. “[Based on the primary efficacy analysis of this trial with a docetaxel-containing control regimen], after a median follow-up of 5.3 years, the primary and secondary time-to-event outcomes all favored the [dose-dense schedule], although only the difference in event-free survival was significant.”  

Patients from 86 sites in Austria, Germany, and Sweden who had undergone primary surgery for nonmetastatic disease were randomly assigned to receive tailored dose-dense (n = 1,001) or standard (n = 1,002) chemotherapy. The dose-dense regimen consisted of four cycles of epirubicin plus cyclophosphamide every 2 weeks followed by four cycles of docetaxel every 2 weeks, with doses tailored according to a predefined hematologic toxicity algorithm. Patients allocated to the standard regimen received three cycles of fluorouracil and epirubicin plus cyclophosphamide every 3 weeks followed by three cycles of docetaxel every 3 weeks.

At the time of this analysis, follow-up data were provided for a median of 10.3 years. Dose-dense vs standard chemotherapy was found to improve breast cancer recurrence–free (hazard ratio [HR] = 0.80; P = .030), event-free (HR = 0.78; P = .009), and distant disease–free (HR = 0.79; P = .030) survival. However, the investigators reported no statistically significant improvement in overall survival (HR = 0.82; P = .109).

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

Journal of Clinical Oncology

---