Breast Cancer Coverage from Every Angle

Neoadjuvant Regimens Compared in Advanced Operable Breast Cancer

By: Vanessa A. Carter, BS
Posted: Friday, February 19, 2021

Inhwan Hwang, MD, of the Veterans Health Service Medical Center, Seoul, Korea, and colleagues devised a study to compare the efficacy of eight cycles of doxorubicin plus cyclophosphamide followed by docetaxel (AC4-D4) versus six cycles of fluorouracil, epirubicin, and cyclophosphamide followed by docetaxel (FEC3-D3) in stage II or III operable breast cancer. The investigators demonstrated comparable results for both therapies, and their work was presented at the 2020 San Antonio Breast Cancer Symposium (Abstract PS13-07).

A total of 252 patients with stage II or III breast cancer were enrolled. Individuals were stratified depending on their HER2 expression and hormone receptor status and were randomly assigned 1:1 to either the AC4-D4 arm or the FEC3-D3 arm.

A total of 222 participants were included for analysis. Other patients discontinued therapy due to ineligibility, disease progression, or withdrawal of written consent. In the AC4-D4 and FEC3-D3 arms, the median patient age was 47 and 48, and about one-quarter of patients had triple-negative breast cancer.

Pathologic complete response was achieved in 14.3% of patients in the AC4-D4 group and 2.0% of patients in the FEC3-D3 group, according to the intent-to-treat analysis. Clinical response (mostly partial responses) occurred in 95 patients in the AC4-D4 arm, with 17.5% of them achieving a pathologic complete response. In the FEC3-D3 arm, clinical response (again, mostly partial responses) was noted in 97 patients, 12.6% of them achieving a pathologic complete response.

Dose modification was performed in 29.4% of patients in the AC4-D4 arm and 20% of patients in the FEC3-D3 arm. The disease-free survival rates at 3 years for AC4-D4 and FEC3-D3 were 77.0% and 74.9%, respectively.

Grade 3 to 4 neutropenia was the most common adverse event in both groups, with 34.9% and 31.2% affected in the AC4-D4 and FEC3-D3 groups, respectively. Hyperglycemia occurred in 3.2% of all patients.

Disclosure: For full disclosures of study authors, visit

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