Combined chemotherapy regimens effective for metastatic breast cancer
MedWire News: Epirubicin plus cyclophosphamide (EC) and epirubicin plus docetaxel (ED) are highly effective combinations for first-line chemotherapy of metastatic breast cancer (MBC), research shows.
Treatment goals for metastatic breast cancer are to prolong survival, prolong disease control, and provide better palliation for patients, remark Peter Schmid (Imperial College London, UK) and colleagues.
In this randomized phase III trial, Schmid and team compared the efficacy and safety of EC with that of ED in 236 patients with histologically confirmed MBC.
The cohort was randomly assigned to receive ED (epirubicin 75 mg/m2 and docetaxel 75 mg/m2) or EC (epirubicin 90 mg/m2 and cyclophosphamide 600 mg/m2) at 3-week intervals for six to eight treatment cycles.
The researchers report that the objective response rate (ORR) did not differ significantly between the two treatment arms. Patients who received EC had an ORR of 42%, compared with 47% among those who received ED.
During a median follow-up of 24 months, tumor progression was observed in 171 (71% in the EC arm and 73% in the ED arm) of the 236 patients. The median progression-free survival time was comparable in each arm, at 10.1 months for EC patients and 10.3 months for ED patients.
Overall survival was also similar between the two groups, at 19.9 months for EC and 30.0 months for ED. The 1-year survival rate was 65.8% for patients in the EC group and 75.8% for patients treated with ED.
In addition, there were no significant differences in the incidence of febrile neutropenia and grade 3 or 4 infections between the two treatment arms, but grade 3 or 4 leucopenia occurred more frequently with ED than with EC, at 81% versus 73%, respectively.
Grade 3 or 4 non-hematologic toxicity was infrequent in both arms, while congestive heart failure was observed in one patient in each arm.
"This randomized trial confirmed the tolerability and the expected high antitumor activity of anthracycline-based combination chemotherapy as first-line treatment of MBC," conclude Schmid and co-authors in the Annals of Oncology.
"The study failed, however, to demonstrate a benefit of the taxane-anthracycline combination over the taxane-free combination," they add.
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By Laura Dean