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Adjuvant docetaxel, doxorubicin, and cyclophosphamide in node-positive breast cancer: 10-year follow-up of the phase 3 randomised BCIRG 001 trial - 29/12/12

Doi : 10.1016/S1470-2045(12)70525-9 
John R Mackey, ProfMD a, Miguel Martin, ProfMD b, , Tadeusz Pienkowski, ProfMD c, Janusz Rolski, MD d, Jean-Paul Guastalla, MD e, Amer Sami, MD f, John Glaspy, MD g, Eva Juhos, MD h, Andrew Wardley, MD i, Tommy Fornander, MD j, John Hainsworth, MD k, Robert Coleman, MD l, Manuel R Modiano, MD m, Jeferson Vinholes, MD n, Tamas Pinter, MD o, Álvaro Rodríguez-Lescure, MD p, Bruce Colwell, MD q, Pierre Whitlock, MD r, Louise Provencher, MD s, Kara Laing, MD t, David Walde, MD u, Chris Price, MD v, Judith C Hugh, MD a, Barrett H Childs, MD w, Kimberly Bassi, BS w, Mary-Ann Lindsay, PharmD x, Véronique Wilson, MSc x, Matthieu Rupin, MSc x, Vincent Houé, MSc x, Charles Vogel, MD y

for the TRIO/BCIRG 001 investigators

  Other TRIO/BCIRG 001 investigators are listed in the Supplementary Material

a Cross Cancer Institute, Edmonton, AB, Canada 
b Hospital General Universitario Gregorio Marañon, Universidad Complutense, Madrid, Spain 
c European Health Centre, Otwock, Poland 
d Podkarpackie Centrum Onkologii, Rzeszów, Poland 
e Centre Leon Berard, Lyon, France 
f Saskatoon Cancer Centre, SK, Canada 
g Translational Oncology Research International, Los Angeles, CA, USA 
h National Institute of Oncology, Budapest, Hungary 
i Christie Hospital, Manchester, UK 
j Stockholm Soder Hospital, Stockholm, Sweden 
k Sarah Cannon Research Institute, Nashville, TN, USA 
l Weston Park Hospital, Sheffield, UK 
m Arizona Clinical Research Center, Tucson, AZ, USA 
n Clinica de Oncologia de Porto Alegre, Porto Alegre, Brazil 
o Petz Aladar County Hospital, Gyor, Hungary 
p Hospital General de Elche, Elche, Spain 
q QEII Health Sciences Centre, Halifax, NS, Canada 
r Centre d’Oncologie Dr Leon Richard, Moncton, NB, Canada 
s Centre des Maladies du Sein, Hôpital du Saint-Sacrement, Quebec City, QC, Canada 
t Dr H Bliss Murphy Cancer Centre, St John’s, NL, Canada 
u Algoma District Cancer Program, Sault Ste Marie, ON, Canada 
v Bristol Haematology and Oncology Centre, Bristol, UK 
w Sanofi, Bridgewater, NJ, USA 
x Translational Research In Oncology, Edmonton, AB, Canada 
y Lynn Cancer Institute, Boca Raton, FL, USA 

* Correspondence to: Prof Miguel Martin, GEICAM, Servicio de Oncologia Medica, Hospital Universitario Gregorio Marañón, Universidad Complutense, 28007 Madrid, Spain

Summary

Background

We compared standard adjuvant anthracycline chemotherapy with anthracycline–taxane combination chemotherapy in women with operable node-positive breast cancer. Here we report the final, 10-year follow-up analysis of disease-free survival, overall survival, and long-term safety.

Methods

BCIRG 001 was an open label, phase 3, multicentre trial in which 1491 patients aged 18–70 years with node-positive, early breast cancer and a Karnofsky score of 80% or more were randomly assigned to adjuvant treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC) or fluorouracil, doxorubicin, and cyclophosphamide (FAC) every 3 weeks for six cycles. Randomisation was stratified according to institution and number of involved axillary lymph nodes per patient (one to three vs four or more). Disease-free survival was the primary endpoint and was defined as the interval between randomisation and breast cancer relapse, second primary cancer, or death, whichever occurred first. Efficacy analyses were based on the intention-to-treat principle. BCIRG 001 is registered with ClinicalTrials.gov, number NCT00688740.

Findings

Enrolement took place between June 11, 1997 and June 3, 1999; 745 patients were assigned to receive TAC and 746 patients were assigned to receive FAC. After a median follow-up of 124 months (IQR 90–126), disease-free survival was 62% (95% CI 58–65) for patients in the TAC group and 55% (51–59) for patients in the FAC group (hazard ratio [HR] 0·80, 95% CI 0·68–0·93; log-rank p=0·0043). 10-year overall survival was 76% (95% CI 72–79) for patients in the TAC group and 69% (65–72) for patients in the FAC group (HR 0·74, 0·61–0·90; log-rank p=0·0020). TAC improved disease-free survival relative to FAC irrespective of nodal, hormone receptor, and HER2 status, although not all differences were significant in these subgroup analyses. Grade 3–4 heart failure occurred in 26 (3%) patients in the TAC group and 17 (2%) patients in the FAC group, and caused death in two patients in the TAC group and four patients in the FAC group. A substantial decrease in left ventricular ejection fraction (defined as a relative decrease from baseline of 20% or more) was seen in 58 (17%) patients who received TAC and 41 (15%) patients who received FAC. Six patients who received TAC developed leukaemia or myelodysplasia, as did three patients who received FAC.

Interpretation

Our results provide evidence that the initial therapeutic outcomes seen at the 5-year follow-up with a docetaxel-containing adjuvant regimen are maintained at 10 years. However, a substantial percentage of patients had a decrease in left ventricular ejection fraction, probably caused by anthracycline therapy, which warrants further investigation.

Funding

Sanofi.

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Vol 14 - N° 1

P. 72-80 - janvier 2013 Retour au numéro
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