Non-anthracycline-containing docetaxel and cyclophosphamide regimen is associated with sustained worse outcome compared with docetaxel, anthracycline and cyclophosphamide in neoadjuvant treatment of triple negative and HER2-positive breast cancer patients: updated follow-up data from NATT study.
OBJECTIVE
A previous study demonstrated that non-anthracycline-containing docetaxel plus cyclophosphamide (TC) regimen was inferior to docetaxel, anthracycline and cyclophosphamide (TAC) in neoadjuvant treatment of triple-negative breast cancer (TNBC) and human epidermal growth factor receptor-2-(HER2)-positive breast cancer in a short-term follow-up. Herein, long-term follow-up survival outcomes have been investigated.


METHODS
TNBC or HER2-positive patients were randomized to receive 6 cycles of TC or TAC neoadjuvant treatment. The primary endpoint was pathological complete remission (pCR). Secondary endpoints included clinical response rate, event-free survival (EFS), and overall survival (OS).


RESULTS
A cohort of 96 patients consisted of 45 in TC and 51 in TAC arm. With a median follow-up period of 53 (range, 8-76) months, the patients achieving pCR post neoadjuvant chemotherapy exhibited superior EFS and OS than patients without pCR (P<0.05). TAC treatment resulted in consistently better EFS than TC treatment: the estimated 5-year EFS was 66.1%vs. 29.8% (P=0.002). Moreover, the estimated 5-year OS was also in favor of TAC: 88.4%vs. 51.6% (P<0.001). Multivariable analysis demonstrated that the treatment regimen was an independent prognostic factor, and patients treated with TAC had a superior EFS [hazard ratio (HR), 0.48; 95% confidence interval (95% CI), 0.26-0.90; P=0.021] and OS (HR, 0.20; 95% CI, 0.08-0.60; P=0.003).


CONCLUSIONS
The updated long-term follow-up data demonstrated a sustained benefit in EFS and OS from anthracycline-containing TAC treatment, indicating that anthracycline is an essential and effective drug in this clinical trial.
Comprehensive Breast Health Center, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Xiaosong
X
Chen
Department of Breast Surgery, The First People's Hospital of Foshan, Foshan 528000, China.
Guolin
G
Ye
Department of Breast Surgery, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, China.
Chenfang
C
Zhang
Department of Breast Surgery, Shanxi Provincial Cancer Hospital, Taiyuan 030013, China.
Xinzheng
X
Li
Comprehensive Breast Health Center, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Kunwei
K
Shen
Breast cancer; HER2; anthracycline; neoadjuvant chemotherapy; survival; triple negative