title: Doxorubicin/cyclophosphamide with concurrent versus sequential docetaxel as neoadjuvant treatment in patients with breast cancer.
abstract: BACKGROUND
  This study was designed to determine whether delivering neo-adjuvant chemotherapy at a higher dose in a shorter period of time improves outcome of breast cancer patients.
  
  
  METHODS
  Women with newly diagnosed breast cancer were randomly assigned to neoadjuvant chemotherapy of four cycles of doxorubicin and cyclophosphamide followed by four cycles of docetaxel (AC 60/600 - T 100 mg/m(2)) or six cycles of TAC (75/50/500 mg/m(2)) every 3 weeks. The primary endpoint was the pathologic complete response (pCR) rate, defined as no invasive tumour present in the breast.
  
  
  RESULTS
  In total, 201 patients were included. Baseline characteristics were well balanced. AC-T resulted in pCR in 21% and TAC in 16% of patients (odds ratio 1.44 (95% confidence interval (CI) 0.67-3.10). AC-T without primary granulocyte-colony stimulating factor (G-CSF) prophylaxis was associated with more febrile neutropenia compared to TAC with primary G-CSF prophylaxis (23% versus 9%), and with more grade 3/4 sensory neuropathy (5% versus 0%).
  
  
  CONCLUSIONS
  With a higher cumulative dose for the concurrent arm, no differences were observed between the two treatment arms with respect to pCR rate. The differential toxicity profile could partly be explained by different use of primary G-CSF prophylaxis.
authors.affiliation: Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: B E P J
authors.initials: BE
authors.lastname: Vriens
authors.forename: M J B
authors.initials: MJ
authors.lastname: Aarts
authors.forename: B
authors.initials: B
authors.lastname: de Vries
authors.forename: S M
authors.initials: SM
authors.lastname: van Gastel
authors.forename: J
authors.initials: J
authors.lastname: Wals
authors.forename: T J
authors.initials: TJ
authors.lastname: Smilde
authors.forename: L J C
authors.initials: LJ
authors.lastname: van Warmerdam
authors.forename: M
authors.initials: M
authors.lastname: de Boer
authors.forename: D J
authors.initials: DJ
authors.lastname: van Spronsen
authors.forename: G F
authors.initials: GF
authors.lastname: Borm
authors.forename: V C G
authors.initials: VC
authors.lastname: Tjan-Heijnen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D000077143:Docetaxel; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D004317:Doxorubicin; D003520:Cyclophosphamide
keywords: Breast cancer; Cyclophosphamide; Docetaxel; Doxorubicin; Neoadjuvant chemotherapy