| Author/Editor | Veitch, Zachary; Khan, Omar F.; Tilley, Derek; Tang, Patricia; Ribnikar, Domen; Stewart, Douglas A.; Kostaras, Xanthoula; King, Karen; Lupichuk, Sasha | |
| Title | Impact of cumulative chemotherapy dose on survival with adjuvant FEC-D chemotherapy for breast cancer | |
| Type | članek | |
| Vol. and No. | Letnik 17, št. 8 | |
| Publication year | 2019 | |
| Volume | str. 957-967 | |
| ISSN | 1540-1405 - Journal of the National Comprehensive Cancer Network : JNCCN | |
| Language | eng | |
| Abstract | Reductions in adjuvant chemotherapy dose <85% for historical regimens (ie, cyclophosphamide/methotrexate/fluorouracil) are known to affect breast cancer survival. This threshold, in addition to early versus late dose reductions, are poorly defined for third-generation anthracycline/taxane-based chemotherapy. In patients with breast cancer receiving adjuvant 5-fluorouracil/epirubicin/cyclophosphamide followed by docetaxel (FEC-D), we evaluated the impact of chemotherapy total cumulative dose (TCD), and early (FEC) versus late (D only) dose reductions, on survival outcomes. Patients and methods: Women with stage I-III, hormone receptor-positive/negative, HER2-negative breast cancer treated with adjuvant FEC-D chemotherapy from 2007 through 2014 in Alberta, Canada, were included. TCD for cycles 1 to 6 of <85% or %85% was calculated. Average cumulative dose was also calculated for early (cycles 1-3) and late (cycles 4-6) chemotherapy. Survival outcomes (disease-free survival [DFS] and overall survival [OS]) were estimated using Kaplan-Meier and multivariate analysis. Cohorts were evaluated for uniformity. Results: Characteristics were reasonably balanced for all cohorts. Overall, 1,302 patients were evaluated for dose reductions, with 16% being reduced <85% (n=202) relative to %85% (n=1,100; 84%). Patients who received TCD %85% relative to <85% had superior 5-year DFS (P=.025) and OS (P<.001) according to Kaplan-Meier analysis, which remained significant on univariate and multivariate analyses. In stratified late and early dose reduction cohorts, DFS and OS showed a significant inferior survival trend for dose reduction early in treatment administration in 5-year Kaplan-Meier (P=.002 and P<.001, respectively) and multivariate analyses (hazard ratio [HR], 1.46; P=.073, and HR, 1.77; P=.011, respectively). Dose delays of <14 or %14 days and granulocyte colony-stimulating factor use did not affect outcomes. Conclusions: Chemotherapy TCD <85% for adjuvant FEC-D affects breast cancer survival. Late reductions (D only) were not shown to adversely affect DFS or OS. Conversely, early reductions (FEC%D) negatively affected patient outcomes. | |
| Keywords | rak dojke kemoterapija adjuvantna kemoterapija preživetje breast cancer chemotherapy adjuvant chemotherapy survival |