A trial comparing three adjuvant chemotherapy regimens in the treatment of women with breast cancer

This study compared the effectiveness of three adjuvant chemotherapy regimens used in the treatment of node positive breast cancer.

Adjuvant chemotherapy refers to chemotherapy given in addition to surgery in an attempt to destroy any remaining cancer cells and to prevent cancer recurrence. Adjuvant chemotherapy is considered the standard of care for node positive patients (patients in which the cancer has spread into nearby lymph nodes). Examples of commonly used chemotherapy agents include docetaxel, doxorubicin, cyclophosphamide, and paclitaxel. However, the most beneficial combination and dosage is still under some debate, and new regimens are constantly being evaluated in an attempt to increase survival and reduce the many toxic side effects associated with chemotherapy.

4,894 women diagnosed with node positive breast cancer took part in this study. Patients received one of three adjuvant chemotherapy regimens after surgery. Group A received a combination of docetaxel, doxorubicin, and cyclophosphamide (TAC). Group B received high doses (DD) of doxorubicin and cyclophosphamide followed by high doses of paclitaxel (DD AC3P). Group C received high doses of AC3P followed by gemcitabine (DD AC3PG). The efficiency of these treatments was assessed by comparing disease-free survival (DFS; the length of time between treatment and until the cancer returns or the patient dies) and the amount of treatment related side effects.

Results showed that the addition of gemcitibine (in the DD AC3PG group) did not improve patient outcome. No difference was seen in DFS between patients in groups A, B or C. The 5-year DFS rate was 80.6% of patients in group A, 82.2% of patients in group B and 80.2% of patients in group C.

In group A, 9% of patients suffered from neutropenia (a low number of immune cells, increasing the risk of serious infections), and 7% reported severe diarrhea. In groups B and C the most common side effect was nerve damage, reported in 6% to 7% of patients.

All three chemotherapy regimens tested in this trial showed a similar benefit in the treatment of breast cancer patients. The addition of gemcitabine to standard chemotherapy does not seem to offer any additional benefit in regards to survival or toxic side effects.

Consult with your physician regarding the various chemotherapy regimens available for the treatment of node positive breast cancer.