The number of deaths from breast cancer in the United States and many other countries has halved over the last 30 years because of a series of step-by-step improvements in treatment that, together, add up to make a big difference. It is important to continue to find out whether or not there are worthwhile benefits from one treatment compared to another
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Risk of breast cancer recurrence and death reduced
The results of an EBCTCG meta-analysis study, which were presented at the San Antonio Breast Cancer Symposium 2017 this week, revealed that increasing the dose intensity of chemotherapy shortening the intervals between cycles or replacing concurrent administration with sequential administration of the drugs lessened the risk of early-stage breast cancer recurrence and death.
The study aimed to discover if an increased dose of drug delivered per unit time has more of an impact than standard chemotherapy regimes for reducing the risk of breast cancer recurrence and death in patients with early-stage breast cancer.
Another way of increasing the dose intensity of chemotherapy is to give the chemotherapeutics individually in sequence rather than administering all the drugs together at the same time. This sequential approach allows higher doses of the individual drugs to be used in each cycle while keeping the side effects manageable
Gray and his colleagues amassed the individual patient data of 10,004 women from 7 randomised trials which tested chemotherapy administered every 2 weeks in comparison with every 3 weeks; they also collated the individual patient data of 11,533 women from 9 randomised trials which tested sequential versus concurrent anthracycline and taxane-based chemos.
The likelihood of disease recurrence and death (within 10 years) lowered by 15% and 17% respectively for patients who received chemotherapy every 2 weeks compared with those who received treatment ever 3 weeks.
Patients who received sequential rather than concurrent chemo had a 14% and 13% reduced risk of disease recurrence and death (within 10 years) respectively.
The results apply to most women receiving chemotherapy for early-stage breast cancer: the 15% reduction in recurrence with does-intense chemotherapy across all trials was similar in ER-positive and in ER-negative disease, and did not differ significantly by any other patient or tumour characteristics, including age, HER2 status, nodal status, tumours size and grade… Some centres prefer giving chemotherapy every 3 weeks and offer treatment every 2 weeks less frequently because of concerns about side effects and uncertainty about the additional benefit. Looking at the data from large numbers of women receiving dose-intense chemotherapy, we have found no evidence to justify these concerns, and the results show consistent benefit from the more intense treatments. A limitation of the study is that the chemotherapy used in the dose-intensification trials varied in the doses, the number of treatment cycles, and the agents used. So, although dose-intense chemotherapy is clearly more effective at eradicating cancers, it is difficult to recommend any one particular dose-intense chemotherapy regimen based on this study
This study was funded by Cancer Research UK and the UK Medical Research Council. Gray declares no conflicts of interest.
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