Increasing the dose intensity of chemotherapy may lower the risk of breast cancer recurrence and death

December 6, 2017, American Association for Cancer Research

Increasing the dose intensity of chemotherapy by either shortening the intervals between the cycles or by sequential administration instead of concurrent administration of the drugs reduced the risk of early-stage breast cancer recurrence and death compared with standard chemotherapy regimens, according to data from an EBCTCG meta-analysis study presented at the 2017 San Antonio Breast Cancer Symposium, held Dec. 5–9.

"The number of deaths from in the United States and many other countries has halved over the last 30 years because of a series of step-by-step improvements in that, together, add up to make a big difference," said Richard Gray, MSc, professor of medical statistics in the Nuffield Department of Population Health at University of Oxford, United Kingdom. "It is important to continue to find out whether or not there are worthwhile benefits from one treatment compared to another."

Gray and colleagues aimed to find out whether increasing the dose intensity of chemotherapy, meaning increasing the amount of drug delivered per unit time, was more effective at lowering and death rates than standard chemotherapy regimens for patients with early-stage breast . The dose-dense chemotherapy trials used the same at the same doses but administered every two weeks instead of every three weeks. The average weekly dose is therefore 1.5 times higher in the dose-dense group than with the standard schedule comparator, Gray explained.

"Another way of increasing the dose intensity of chemotherapy is to give the chemotherapeutics individually in sequence rather than administering all the drugs together at the same time," said Gray. This sequential approach allows higher doses of the individual drugs to be used in each cycle while keeping the side effects manageable, he added.

For the meta-analysis, Gray and team used individual patient data from seven randomized trials (10,004 women) that tested chemotherapy given every two weeks versus every three weeks, and from nine randomized trials (11,533 women) that tested sequential versus concurrent anthracycline and taxane-based chemotherapies.

"We were surprised by how strong and consistent the findings from our study were," Gray said.

Patients who received chemotherapy every two weeks were 17 percent and 15 percent less likely to have disease recurrence and die from breast cancer within 10 years, respectively, compared with those who received treatment every three weeks.

Similarly, patients who received sequential chemotherapy were 14 percent and 13 percent less likely to have disease recurrence and die from breast cancer within 10 years, respectively, compared with those who received concurrent treatment.

"The results apply to most women receiving chemotherapy for : the 15 percent reduction in recurrence with dose-intense chemotherapy across all trials was similar in ER-positive and in ER-negative disease, and did not differ significantly by any other patient or tumor characteristics, including age, HER2 status, nodal status, tumor size, and grade," noted Gray.

There were few additional side-effects with dose-intense schedule compared with standard schedule chemotherapy, and fewer patients who received dose-intense treatment died from non-breast cancer causes than those who received standard treatment.

"Some centers prefer giving chemotherapy every three weeks and offer treatment every two weeks less frequently because of concerns about side effects and uncertainty about the additional benefit. Looking at the data from large numbers of women receiving dose-intense chemotherapy, we have found no evidence to justify these concerns, and the results show consistent benefit from the more intense treatments," Gray said.

A limitation of the study is that the chemotherapy used in the dose-intensification trials varied in the doses, the number of treatment cycles, and the agents used. So, although dose-intense chemotherapy is clearly more effective at eradicating cancers, it is difficult to recommend any one particular dose-intense regimen based on this study, said Gray.

Explore further: Tailored, dense-dose chemotherapy for early breast cancer does not result in significant improvement

Related Stories

Tailored, dense-dose chemotherapy for early breast cancer does not result in significant improvement

November 8, 2016
Among women with high-risk early breast cancer, the use of tailored dose-dense chemotherapy compared with standard adjuvant chemotherapy did not result in a statistically significant improvement in breast cancer recurrence-free ...

Trial confirms pelvic radiation as standard of care for high-risk endometrial cancer

September 25, 2017
In a new phase III trial report from the National Clinical Trial Network group, NRG Oncology, recurrence-free and overall survival rates for women with stage I-II high-risk endometrial cancer were not superior following vaginal ...

Long-term survival rates double previous estimates for locally advanced lung cancer

September 25, 2017
Long-term results of a phase III clinical trial indicate that survival rates for patients receiving chemoradiation for unresectable, locally advanced non-small cell lung cancer (NSCLC) may be more than twice as high as previous ...

Certain breast CA patients benefit from adjuvant capecitabine

June 1, 2017
(HealthDay)—Capecitabine (Xeloda) can extend the lives of patients with human epidermal growth factor receptor 2 (HER2)-negative breast cancer who have residual invasive disease after receipt of neoadjuvant chemotherapy, ...

Cannabinoids used in sequence with chemotherapy are a more effective treatment for cancer

June 5, 2017
New research has confirmed that cannabinoids - the active chemicals in cannabis - are effective in killing leukaemia cells, particularly when used in combination with chemotherapy treatments.

'Dose-dense' chemo for premenopausal breast cancer patients improves survival

March 10, 2016
Amsterdam, The Netherlands: Premenopausal women with breast cancer have a better chance of survival if they are given cycles of adjuvant chemotherapy closer together, every two weeks rather than every three weeks. Furthermore, ...

Recommended for you

Function of neutrophils during tumor progression unraveled

October 15, 2018
Researchers at The Wistar Institute have characterized the function of neutrophils, a type of white blood cells, during early stages of tumor progression, showing that they migrate from the bone marrow to distant sites and ...

Delving where few others have gone, leukemia researchers open new path

October 15, 2018
A Wilmot Cancer Institute study uncovers how a single gene could be at fault in acute myeloid leukemia (AML), one of the deadliest cancers. The breakthrough gives researchers renewed hope that a gene-targeted therapy could ...

3-D mammography detected 34% more breast cancers in screening

October 15, 2018
In traditional mammography screening, all breast tissue is captured in a single image. Breast tomosynthesis, on the other hand, is three-dimensional and works according to the same principle as what is known as tomography. ...

More clues revealed in link between normal breast changes and invasive breast cancer

October 15, 2018
A research team, led by investigators from Georgetown Lombardi Comprehensive Cancer Center, details how a natural and dramatic process—changes in mammary glands to accommodate breastfeeding—uses a molecular process believed ...

Cancer stem cells use 'normal' genes in abnormal ways

October 12, 2018
CDK1 is a "normal" protein—its presence drives cells through the cycle of replication. And MHC Class I molecules are "normal" as well—they present bits of proteins on the surfaces of cells for examination by the immune ...

Obesity linked to increased risk of early-onset colorectal cancer

October 12, 2018
Women who are overweight or obese have up to twice the risk of developing colorectal cancer before age 50 as women who have what is considered a normal body mass index (BMI), according to new research led by Washington University ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.