Four vs. Six cycles of Docetaxel and Cyclophosphamide in Early Breast Cancer.

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Background: 
    • The ABC trials established the use of non-anthracycline containing regimen:
      • Docetaxel and cyclophosphamide (TC) as adjuvant therapy in early breast cancer
    • In clinical practice, TC is commonly used in:
      • Stage I Triple Negative (TN)
      • Stage I,II hormone positive breast cancer
    • However, no specific recommendations exist in literature, regarding the number of cycles that can be used:
      • For example TC 4 vs TC 6
    • The aim of this study, was to determine if TC 4 is non-inferior to TC6 when used as adjuvant therapy in early breast cancer
  • Methods: 
    • They retrospectively reviewed 143 patients who were diagnosed with early breast cancer, between 2007 to 2017, at there institution who had received either TC 4 or TC 6 as adjuvant therapy
    • The number of cycles the patients received were based on provider preference
    • The two groups (TC 4, TC 6) were compared in regard to stage of cancer at diagnosis based on AJCC 7th edition-stratified by TNM staging for hormone positive and T staging only for TN, grade of adverse events, recurrence and death from breast cancer
    • Median follow up was 5 years
  • Results: 
    • Out of the 143, 102 (71.3%) received TC 4 and 41 (28.7%) received TC 6
    • Among the hormone positive, 42 were stage I and out of which 32 (76.2%) received TC 4 and 10 (23.8%) received TC 6 and there were 24 stage II patients, out of which 17 (70.8%) received TC 4 and 7 (29.2%) received TC 6
    • Among the TN group, there were 64 who were T1, out of which 45 (70.3%) received TC 4 and 19 (29.7%) received TC 6, while there were 12 T2 patients, out of which 7 (58.3%) received TC 4 and 5(41.7%) received TC 6
    • Recurrence of breast cancer was seen in 5 (4.9%) in TC 4 and 3 (7.3%) in TC 6, p=0.569
    • Death due to breast cancer was seen in 2 (1.9%) in TC 4 and 1 (2.4%) in TC 6, p=0.856
    • Adverse events were seen in 86 (84.3%) in TC 4 and 39 (95.1%) in TC 6,p=0.078
    • Adverse events of Grade 3 or higher were seen in 10 (9.8%) in TC 4 and 11 (26.8%) in TC6, p=0.09
  • Conclusions: In this limited series, TC 4 appears to be equally effective to TC 6, with fewer adverse events of any grade and lower incidence of Grade 3 or higher side effects which was statistically significant
  • Although the proportion of patients who received TC 4 were higher in these series, the percentage of patients who received TC 6 was higher in stage II for hormone positive and T2 for TN when compared to Stage 1 and T1 respectively
  • They also found a higher percentage of recurrence and death due to breast cancer in TC 6 which was not statistically significant and this likely a reflection of the fact that as mentioned above patient with a higher stage at diagnosis tended to receive 6 cycles as compared to 4 cycles and therefore had a higher chance of recurrence in the future
Unknown's avatar

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

Leave a comment