Dose-dense adjuvant Taxotere containing regimens for breast cancer – pro

Dose dense Taxotere after CA chemotherapy has been studied in dose dense fashion. The administration of DOC before AC results in fewer DOC dose reductions and a higher RDI than the reverse sequence. Larger trials evaluating the sequence of DOC before anthracyclines are justified.

Dose dense therapy has been studied in the metastatic, adjuvant and neoadjuvant setting. Most studies use paclitaxel(Taxol)To my knowledge, for Taxotere there is only one study in the adjuvant setting in dose dense fashion. A European study using the TEC regimen concluded: “Dose-dense regimens yield more frequent and severe nonhematological toxic effects than standard dose TEC regimen. Though grade 4 toxicity rates appear acceptable with the TEC regimen, the incidence of grade 3–4 events makes it difficult to recommend either dose-dense regimen for further investigation.” However, in 2008, a phase II study did look at the Ac + Taxotere dose dense regimen.

Fifty-six patients with axillary node-positive, nonmetastatic breast cancer were randomly assigned either to group A (docetaxel [DOC] 75 mg/m2 intravenously [IV] every 14 days for four cycles followed by doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 [AC] IV every 14 days for four cycles); or to group B (AC followed by DOC) at the identical doses and schedule. Pegfilgrastim 6 mg subcutaneous injection was administered 1 day after the chemotherapy in all treatment cycles. The primary objective was to administer DOC without dose reductions or delays before or after AC and calculate the relative dose intensity (RDI) of DOC and AC. The administration of DOC before AC resulted in fewer DOC dose reductions and a higher RDI than the reverse sequence. It concluded that larger trials evaluating the sequence of DOC before anthracyclines are justified. To my knowledge there are no studies using doise dense AC followed by q 3 weekly Taxotere. There are other dose dense regimens that incldue docetaxel, but each of them stands alone and , therefore, there remain a pautcity of infomration on how to combine docetaxel with other drugs in dose dense fashionl unlike the many studies that define the role of dose dense paclitaxel.

Jackisch C, Von Minckwitz G, Raab G, et al. Primary endpoint analysis of the GEPARDUO study — preoperative chemotherapy comparing dose-dense versus sequential Adriamycin/docetaxel combination in operable breast cancer. Program and abstracts of the 25th Annual San Antonio Breast Cancer Symposium; December 11-14, 2002; San Antonio, Texas. Abstract 152.

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Feasibility and safety of dose-dense docetaxel after conventional epirubicin and cyclophosphamide as adjuvant treatment for early breast cancer patients; Sanna G, Pestrin M, Zafarana E, Biagioni C, Cavaciocchi D, Turner N, Di Leo A, Biganzoli L; The Breast (May 2013)

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