Evaluation of anemia, neutropenia and skin toxicities in standard or dose-dense doxorubicin/cyclophosphamide (AC)–paclitaxel or docetaxel adjuvant chemotherapy in breast cancer
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Abstract
Results of CALGB 9741 demonstrated that administering standard doxorubicin/cyclophosphamide
(AC)-paclitaxel therapy for adjuvant therapy of breast cancer in a dose-dense fashion
with colony-stimulating factors increases efficacy, decreases severe neutropenia,
but may increase the need for blood transfusions. A chart review was performed to
evaluate the rates of anemia, neutropenia and skin toxicities with dose-dense and
traditional AC-taxane chemotherapy.
A total of 112 patients received one of four treatments: non-dose-dense AC-paclitaxel
(NDD Pac), dose-dense AC-paclitaxel (DD Pac), non dose-dense AC-docetaxel (NDD Doc),
or dose-dense AC-docetaxel (DD Doc).
Transfusion rates were not increased in the dose-dense population; however, rates
of grade 2-4 anemia (23% versus 0%, P=0.029), as well as erythropoietin use (58% versus
0%, P <0.0001), were significantly increased in the DD Pac group compared with the
NDD Pac group. Grade 3 skin toxicities were significantly increased in the DD Doc
group compared with the NDD Doc group (70% versus 11%, P <0.0001).
These results demonstrate that dose-dense AC-taxane therapy may increase rates of
anemia and the need for erythropoietin, and decrease rates of neutropenia. The utility
of DD Doc appears limited by skin toxicities and its use outside of a clinical study
should not be recommended.