Dose-dense anthracycline-based chemotherapy for node-positive breast cancer

Georgiana K. Ellis, Robert B Livingston, Julie R. Gralow, Stephanie J. Green, Tove Thompson

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Purpose: Theoretical considerations and clinical experience suggest that dose-dense chemotherapy may be superior to other approaches using the same drugs. We studied a dose-dense combination of doxorubicin and cyclophosphamide, with or without fluorouracil, as adjuvant therapy. Patients and Methods: Patients with resected breast cancer were treated if they were node-positive and estrogen receptor-negative, positive for overexpression of Her-2-neu, or had four or more involved nodes. Doxorubicin was given weekly to a total dose of 480 mg/m2. Cyclophosphamide 60 mg/m2 was given daily by mouth during the period of doxorubicin treatment. The first 30 patients received fluorouracil at 300 mg/m2/wk intravenously concurrently with doxorubicin administration. In the last 22, it was omitted because of symptomatic hand-foot syndrome in the majority of patients. Filgrastim (granulocyte colony-stimulating factor [G-CSF]) was administered during chemotherapy every day except the day of intravenous administration and continued until 1 week after the completion of the chemotherapy. Results: Between October 20, 1992, and June 10, 1997, we enrolled 52 patients. The mean delivered dose-intensity for doxorubicin was 18.6 mg/m2/wk. Hospitalization was required in 6% of patients for reversible febrile neutropenia. There were no acute treatment-related deaths, but one patient subsequently died of acute leukemia with a characteristic translocation for anthracycline-related exposure. At 5 years, the event-free survival was 86% for all patients (95% confidence interval, 75% to 95%). Conclusion: Continuous dose-dense chemotherapy with G-CSF support produced encouraging results, which seem to be superior to those expected with "standard" doxorubicin and cyclophosphamide chemotherapy. It deserves a test in the form of a randomized trial where this approach to anthrocycline-based treatment is compared with intermittent administration.

Original languageEnglish (US)
Pages (from-to)3637-3643
Number of pages7
JournalJournal of Clinical Oncology
Volume20
Issue number17
DOIs
StatePublished - Sep 1 2002
Externally publishedYes

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Anthracyclines
Doxorubicin
Breast Neoplasms
Drug Therapy
Cyclophosphamide
Granulocyte Colony-Stimulating Factor
Fluorouracil
Hand-Foot Syndrome
Febrile Neutropenia
Therapeutics
Estrogen Receptors
Intravenous Administration
Disease-Free Survival
Mouth
Leukemia
Hospitalization
Confidence Intervals
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Dose-dense anthracycline-based chemotherapy for node-positive breast cancer. / Ellis, Georgiana K.; Livingston, Robert B; Gralow, Julie R.; Green, Stephanie J.; Thompson, Tove.

In: Journal of Clinical Oncology, Vol. 20, No. 17, 01.09.2002, p. 3637-3643.

Research output: Contribution to journalArticle

Ellis, Georgiana K. ; Livingston, Robert B ; Gralow, Julie R. ; Green, Stephanie J. ; Thompson, Tove. / Dose-dense anthracycline-based chemotherapy for node-positive breast cancer. In: Journal of Clinical Oncology. 2002 ; Vol. 20, No. 17. pp. 3637-3643.
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