Dose-Dense Epirubicin and Cyclophosphamide Followed by Weekly Paclitaxel in Node-Positive Breast Cancer

Background. Adding taxanes to anthracycline-based adjuvant chemotherapy has shown significant improvement in node-positive breast cancer patients but the optimal dose schedule has still remained undetermined. Objectives. The feasibility of dose-dense epirubicin in combination with cyclophosphamide (EC) followed by weekly paclitaxel as adjuvant chemotherapy in node-positive breast cancer patients was investigated. Methods. All patients were treated with epirubicin (100？mg/m2) and cyclophosphamide (600？mg/m2) every two weeks for four cycles with daily Pegfilgrastim (G-CSF) that was administered 3–10 days after each cycle of epirubicin and cyclophosphamide infusion which followed by (80？mg/m2) paclitaxel for twelve consecutive weeks. Results. Sixty consecutive patients were analyzed, of whom 57 patients (95%) completed the regimen and no case of toxicity-related death was observed. Grade 3/4 hematologic toxicity was uncommon and the most common grade 3/4 nonhematological adverse event was neuropathy disorders. Conclusions. Dose-dense epirubicin and cyclophosphamide followed by weekly paclitaxel with G-CSF support is a well-tolerated and feasible regimen in node-positive breast cancer patients without serious complications. 1. Introduction Anthracyclines are the most effective drugs in the treatment of breast cancer, and the addition of a taxane to an anthracycline-containing regimen, after or concurrently with anthracycline treatment, appears to provide significant benefit, particularly in node-positive cases [1–3] and the combination of paclitaxel with anthracycline has been reported as an active regimen in improvement of disease-free survival and overall survival [4, 5]. A large number of adjuvant taxane studies have been reported. The CALGB 9141 and NSABP B-28 trials demonstrated that doxorubicin and cyclophosphamide (AC) plus paclitaxel (PAC) is superior to four cycles of AC alone, which in turn has equivalent efficacy to six cycles of cyclophosphamide plus methotrexate and 5-fluorouracil (CMF) [6, 7]. A randomized multicenter phase III study was conducted by Polyzos et al. to compare the sequential docetaxel followed by epirubicin/cyclophosphamide combination with that of epirubicin, cyclophosphamide, and 5-fluorouracil (FEC). The sequential docetaxel followed by epirubicin/cyclophosphamide adjuvant chemotherapy regimen resulted in improved five-year disease-free survival (DFS) in women with axillary node-positive early breast cancer [8]. Also, higher doses (dose intense) and more frequent administration of these drugs (dose-dense) were well tolerated