The effect of reduced RDI of chemotherapy on the outcome of breast cancer patients

Abstract

The aims of this study were to investigate the impact of the relative dose intensity (RDI) of chemotherapy on disease-free survival (DFS) and overall survival (OS), to identify the optimal RDI cutoff points with the docetaxel, epirubicin and cyclophosphamide (TEC) regimen for stage I-III breast cancer patients and to explore the adverse events in these patients. To achieve this, we performed a retrospective analysis of breast cancer patients treated at the First Affiliated Hospital of Chongqing Medical University in 2011. The results showed that among 293 patients with the TEC regimen, 85% and 80% were the cutoff points at which a high RDI was associated with better overall survival (HR = 2.04; 95% CI 1.13, 3.70; p = 0.02) and disease-free survival (HR = 1.97; 95% CI 1.14-3.42; p = 0.02), respectively. Among 169 HR(+) patients, 80% was the cutoff point for DFS (HR = 2.33; 95% CI 1.07-5.08; p = 0.03), and 85% was the cutoff point for OS (HR = 3.00; 95% CI 1.24-7.26; p = 0.02). Among 105 HR(−) patients, 80% was the cutoff point for OS (HR = 2.86; 95% CI 1.05-7.80; p = 0.04). Of 293 patients, neutropenia, nausea, and vomiting were found to be correlated with the level of RDI. In conclusion, a higher RDI of chemotherapy is associated with better survival but with a higher probability of causing adverse events. To optimize survival benefits, the RDI should be maintained ≥ 85% for HR(+) patients and ≥ 80% for HR(−) patients. The current standard of care for breast cancer includes breast surgery, local radiation therapy, systemic adjuvant and neoadjuvant chemotherapy, endocrine therapy and target therapy. Studies have shown the effect of chemotherapy on improving breast cancer survival 1-3. An increased benefit with anthracycline-containing regimens, which have been used increasingly over the past decade, has been recommended by The Early Breast Cancer Trialists' Collaborative Group 4. In addition, support for the adjuvant use of taxanes after an anthracycline-containing regimen was provided by Henderson et al. 's report (Intergroup Study 0148) 1,5. As an increasing number of trials have suggested an increased benefit with anthracycline and taxane-containing regimens, doctors have used taxanes combined with anthracycline as a classical regimen. The most famous clinical trial BCIRG005 suggested that patients receiving both doxorubicin and cyclophosphamide followed by docetaxel (AC-T) and docetaxel in combination with doxorubicin and cyclophosphamide (TAC) had a 79.0% 5-year disease-free survival rate. The 5-year overall survival rates were 89.0% and 88.0%, respectively 6. The 10-year overall survival rate was 79.9% in the ACT arm and 78.9% in the TAC arm. The ACT arm had a 66.5% 10-year disease-free survival rate, and the rate of the TAC arm was 66.3% 7. The survival benefits of the two regimens were similar, but the incidence of grade 3/4 adverse events in the blood system was lower in the ACT regimen than in the TAC regimen 6. However, the TAC regimen with G-CSF support provided a shorter duration of adjuvant therapy w...

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