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JOURNAL OF CLINICAL ONCOLOGY
卷 21, 期 5, 页码 843-850出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1200/JCO.2003.05.135
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Purpose: To compare the efficacy of a standard anthrocycline-based regimen to a dose-intensified anthracycline regimen in locally advanced breast cancer. Patients and Methods., Locally advanced breast cancer patients were randomly assigned onto a study comparing cyclophosphamide (C; 75 mg/m(2) orally days 1 to 14), epirubicin (E; 60 mg/m(2) intravenously [IV] days 1, 8), and fluorouracil (F; 500 mg/m(2) IV days 1, 8) six cycles every 28 days versus E (1120 mg/m 2 IV day 1), C (830 mg/m(2) IV day 1), and granulocyte colony-stimulating factor (filgrastim; 5 mug/kg/d subcutaneously days 2 to 13) six cycles every 14 days. The study was designed to detect a 15% improvement, that is, from 50% to 65% in median progression-free survival (PFS) in favor of the dose-intensified regimen. Results: A total of 448 patients were enrolled over a period of 3 years. The median dose intensity delivered for C and E reached, respectively, 85% and 87% of that planned in the CEF arm and 96% and 95% of that planned in the EC arm. The dose-intensified arm was slightly more emetogenic and generated more grade 3 to 4 anemia but less febrile neutropenia episodes. After a median follow-up of 5.5 years, 277 events have been reported. The median PFS was 34 and 33.7 months for CEF and EC, respectively (P = .68), and the 5-year survival rate was 53% and 51% for CEF and EC, respectively (P = .94). Conclusion: Dose-intensified EC does not provide a measurable therapeutic benefit over CEF as neoadjuvant chemotherapy for unselected locally advanced breast cancer patients. (C) 2003 by American Society of Clinical Oncology.
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