Long-term outcomes of dose-dense chemotherapy for high-risk breast cancer

This study aimed to compare intense dose-dense adjuvant (after surgery) chemotherapy with conventionally scheduled chemotherapy. This study concluded that the dose-dense chemotherapy regime had a better 10-year survival and event free survival rates as compared to conventional chemotherapy. 

Breast cancer patients with extensive spread to the lymph nodes tend to have worse outcomes. Treatment options can include intense dose-dense adjuvant chemotherapy or conventionally scheduled chemotherapy. In a conventional schedule, epirubicin/cyclophosphamide are delivered at the same time, followed by paclitaxel. In a dose-dense schedule, the chemotherapies epirubicin, paclitaxel and cyclophosphamide are delivered in sequence at higher doses.  It is unclear whicch treatment schedule is more effective. 

1284 patients were included in this study. They received either dose-dense chemotherapy (658 patients) or standard conventional dose chemotherapy (626 patients). Patients were followed for an average of 122 months. 

Event free survival (EFS, survival without recurrence of cancer) was 47% in the standard-dose group and 56% in the dose-dense group. 10-year survival after treatment was 59% in the standard group as compared to 69% in the dose-dense group.

This study concluded that dose-dense chemotherapy was associated with better 10 year survival and event free survival rates. 

Nine cases (1.4%) of secondary leukemia (blood cancer) were reported in the dose-dense chemotherapy regime vs. 2 cases (0.3%) in the conventional regime. However, dose-dense chemotherapy still reduced risk of recurrence.