Concurrent doxorubicin plus docetaxel is not more effective than concurrent doxorubicin plus cyclophosphamide in operable breast cancer with 0 to 3 positive axillary nodes

North American breast cancer intergroup trial E 2197

Lori J. Goldstein, Anne O'Neill, Joseph A. Sparano, Edith A. Perez, Lawrence N. Shulman, Silvana Martino, Nancy E. Davidson

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94 Citations (Scopus)

Abstract

Purpose: The combination of doxorubicin and cyclophosphamide (AC) is a standard adjuvant regimen. Doxorubicin and docetaxel (AT) is one of the most active cytotoxic regimens for metastatic breast cancer. The purpose of this trial was to determine whether adjuvant AT improved disease-free survival compared with AC in operable breast cancer. Patients and Methods: Women with invasive breast cancer were eligible if there were one to three positive lymph nodes or if the node-negative tumor was greater than 1 cm. Patients were randomly assigned after surgery to receive doxorubicin (60 mg/m2) plus either cyclophosphamide (600 mg/m2; AC) or docetaxel (60 mg/m2; AT) given every 3 weeks for four cycles, followed by hormone therapy for patients with estrogen receptor (ER) and/or progesterone receptor (PR)-positive tumors. Results: There were 2,882 eligible patients enrolled. After a median follow-up of 79.5 months, there was no significant difference in disease-free survival (DFS; 85% in both arms) or overall survival (91% v 92%) at 5 years. The hazard ratio for AC versus AT was 1.02 (95% CI for DFS, 0.86 to 1.22; P = .78). In an exploratory analysis of prespecified stratification factors by ER and PR expression there were trends toward improved DFS for AT in ER/PR-negative disease. Grade 3 neutropenia associated with fever or infection occurred more often with AT (26% v 10%; P = .05). Conclusion: AT did not improve DFS or overall survival in this population, and was associated with more toxicity.

Original languageEnglish (US)
Pages (from-to)4092-4099
Number of pages8
JournalJournal of Clinical Oncology
Volume26
Issue number25
DOIs
StatePublished - 2008

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docetaxel
Doxorubicin
Cyclophosphamide
Breast Neoplasms
Progesterone Receptors
Estrogen Receptors
Disease-Free Survival
Survival
Neutropenia
Neoplasms
Fever
Lymph Nodes
Hormones

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Concurrent doxorubicin plus docetaxel is not more effective than concurrent doxorubicin plus cyclophosphamide in operable breast cancer with 0 to 3 positive axillary nodes : North American breast cancer intergroup trial E 2197. / Goldstein, Lori J.; O'Neill, Anne; Sparano, Joseph A.; Perez, Edith A.; Shulman, Lawrence N.; Martino, Silvana; Davidson, Nancy E.

In: Journal of Clinical Oncology, Vol. 26, No. 25, 2008, p. 4092-4099.

Research output: Contribution to journalArticle

Goldstein, Lori J. ; O'Neill, Anne ; Sparano, Joseph A. ; Perez, Edith A. ; Shulman, Lawrence N. ; Martino, Silvana ; Davidson, Nancy E. / Concurrent doxorubicin plus docetaxel is not more effective than concurrent doxorubicin plus cyclophosphamide in operable breast cancer with 0 to 3 positive axillary nodes : North American breast cancer intergroup trial E 2197. In: Journal of Clinical Oncology. 2008 ; Vol. 26, No. 25. pp. 4092-4099.
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abstract = "Purpose: The combination of doxorubicin and cyclophosphamide (AC) is a standard adjuvant regimen. Doxorubicin and docetaxel (AT) is one of the most active cytotoxic regimens for metastatic breast cancer. The purpose of this trial was to determine whether adjuvant AT improved disease-free survival compared with AC in operable breast cancer. Patients and Methods: Women with invasive breast cancer were eligible if there were one to three positive lymph nodes or if the node-negative tumor was greater than 1 cm. Patients were randomly assigned after surgery to receive doxorubicin (60 mg/m2) plus either cyclophosphamide (600 mg/m2; AC) or docetaxel (60 mg/m2; AT) given every 3 weeks for four cycles, followed by hormone therapy for patients with estrogen receptor (ER) and/or progesterone receptor (PR)-positive tumors. Results: There were 2,882 eligible patients enrolled. After a median follow-up of 79.5 months, there was no significant difference in disease-free survival (DFS; 85{\%} in both arms) or overall survival (91{\%} v 92{\%}) at 5 years. The hazard ratio for AC versus AT was 1.02 (95{\%} CI for DFS, 0.86 to 1.22; P = .78). In an exploratory analysis of prespecified stratification factors by ER and PR expression there were trends toward improved DFS for AT in ER/PR-negative disease. Grade 3 neutropenia associated with fever or infection occurred more often with AT (26{\%} v 10{\%}; P = .05). Conclusion: AT did not improve DFS or overall survival in this population, and was associated with more toxicity.",
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T1 - Concurrent doxorubicin plus docetaxel is not more effective than concurrent doxorubicin plus cyclophosphamide in operable breast cancer with 0 to 3 positive axillary nodes

T2 - North American breast cancer intergroup trial E 2197

AU - Goldstein, Lori J.

AU - O'Neill, Anne

AU - Sparano, Joseph A.

AU - Perez, Edith A.

AU - Shulman, Lawrence N.

AU - Martino, Silvana

AU - Davidson, Nancy E.

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N2 - Purpose: The combination of doxorubicin and cyclophosphamide (AC) is a standard adjuvant regimen. Doxorubicin and docetaxel (AT) is one of the most active cytotoxic regimens for metastatic breast cancer. The purpose of this trial was to determine whether adjuvant AT improved disease-free survival compared with AC in operable breast cancer. Patients and Methods: Women with invasive breast cancer were eligible if there were one to three positive lymph nodes or if the node-negative tumor was greater than 1 cm. Patients were randomly assigned after surgery to receive doxorubicin (60 mg/m2) plus either cyclophosphamide (600 mg/m2; AC) or docetaxel (60 mg/m2; AT) given every 3 weeks for four cycles, followed by hormone therapy for patients with estrogen receptor (ER) and/or progesterone receptor (PR)-positive tumors. Results: There were 2,882 eligible patients enrolled. After a median follow-up of 79.5 months, there was no significant difference in disease-free survival (DFS; 85% in both arms) or overall survival (91% v 92%) at 5 years. The hazard ratio for AC versus AT was 1.02 (95% CI for DFS, 0.86 to 1.22; P = .78). In an exploratory analysis of prespecified stratification factors by ER and PR expression there were trends toward improved DFS for AT in ER/PR-negative disease. Grade 3 neutropenia associated with fever or infection occurred more often with AT (26% v 10%; P = .05). Conclusion: AT did not improve DFS or overall survival in this population, and was associated with more toxicity.

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