Sequential Anthracycline-Taxane Chemotherapy in Node-positive Breast Cancer Amongst Asian Patients - Real-world Outcomes

Abstract

Abstract Background The use of taxanes in the adjuvant setting has been contradictory in randomized trials. Two meta-analyses supported the use of adjuvant taxanes which have since been incorporated into standard guidelines. However, their benefit needs to be validated in the real-world population. Methods We retrospectively analyzed the outcomes of patients with node positive breast cancer treated with sequential 5-fluorouracil, epirubicin and cyclophosphamide (FEC) and docetaxel (FEC-D) compared to FEC alone in a university hospital in Kuala Lumpur, Malaysia. The primary outcome was overall survival (OS) and the secondary outcomes were disease free survival (DFS) and toxicity. Results Between 2007 and 2011, 318 patients with node-positive breast cancer were recruited with 131 received FEC and 187 received FEC-D. Mean duration of follow up was 59.7 months for both groups. The 5-year OS was significantly higher with FEC-D (78.8% vs 64.2%; p value = 0.014). Greater benefit was seen in postmenopausal patients, patients with 1-3 positive nodes and T2- 4 tumours. The 5-year DFS was no different between the two groups with 55.4% in the FEC arm vs. 69.4% in the FEC-D arm (p value =0.063). However the median DFS was not reached for FEC-D. The use of FEC-D with the hazard ratio 0.6 (95% CI 0.4 - 0.9; p value = 0.014), tumours 2cm or less, 1-3 positive nodes and hormone receptor positivity were prognostic for survival. Patients with FEC-D experienced higher toxicity with hospitalization rates of 25.1% of patients needing at least one hospitalization (p value = 0.005). Grade 3 and 4 febrile neutropenia was higher with FEC-D (22.5% vs. 8.4%, p value = 0.001) as was the use of granulocyte colony stimulating factors (GCSF). The rates of chemotherapy interruptions and dose reductions were similar in both treatment arms. Conclusions Our study confirmed the benefit of sequential anthracycline-taxane chemotherapy in node positive breast cancer in the real-world albeit with higher toxicity.