Adjuvant Dose-Dense Chemotherapy in Breast Cancer: Standard of Care in High-Risk Patients

Abstract

Meta-analyses persistently confirm the superiority of dose-dense chemotherapy in comparison with standard chemotherapy. In contrast, individual studies have shown conflicting results. These may be explained by different risk profiles of the treated patient populations. Some trials show a significant advantage in disease-free survival (DFS) and overall survival (OS) in the estrogen receptor (ER)-negative population only, whereas trials with high-risk populations like GIM-2 (Gruppo Italiano Mammella) and AGO-iddETC (Arbeitsgemeinschaft Gynäkologische Onkologie, intense dose-dense epirubicin, paclitaxel, and cyclophosphamide) show a significant superiority in DFS and OS for both, ER-negative and ER-positive patients even after 7 and 10 years, respectively, of follow-up. In contrast, the 10-year follow-up data of the E1199/Intergroup trial no longer showed any superiority of weekly paclitaxel for ER-positive/HER2-negative patients; superiority was observed in the triple-negative subgroup only. Although a direct head-to-head comparison is missing, iddETC or 4 cycles each of dose-dense epirubicin/cyclophosphamide followed by paclitaxel are the preferred adjuvant regimens for patients at risk. Patients with ≥ 4 positive lymph nodes should preferentially be treated with iddETC.

Do Patients with Luminal A Breast Cancer Profit from Adjuvant Systemic Therapy? A Retrospective Multicenter Study

“…Möbus et al described that patients with more than three affected lymph nodes benefit from this intense therapy [38]. In the period of 2001–2008, the standard chemotherapy was anthracycline based and did not include high intense regimes.…”

Adjuvant Dose-Dense Chemotherapy for Breast Cancer: Available Evidence and Recent Updates

“…The idea of increasing efficacy with reduced toxicity using the same drugs and doses is compelling and makes dose-dense chemotherapy a first-line option in the adjuvant treatment of high-risk breast cancer patients [37]. This option should be discussed with patients regardless of age, tumor stage, or subtype.…”

Updated Survival Analysis after a Median Follow-up of 12 Years of an Anthracycline-Containing Adjuvant Prospective Multicentre, Randomised Phase III Trial on Dose-Dense Chemotherapy in Primary Node-Positive, High-Risk Breast Cancer Patients

“…When the studies on dose-dense/dose-intensified therapy were designed, they varied in regard to their schedule, sequences and dose density. There was the option of shortening the intervals (dose dense: every 2 weeks instead of every 3 weeks) and/or increasing their dosing (dose dense and dose intensified) [14,16,25]. The published studies are not always homogeneous regarding the way of increasing the dose (dose dense vs. dose intensified) and therefore it is not always possible to clearly separate those approaches.…”

“…Reasons for this difference have been discussed extensively [14][15][16]. Differences in the patients' risk profiles with inhomogeneous amounts of positive axillary lymph nodes have been considered as one possible explanation for inconsistent results.…”