Dose-dense chemotherapy in nonmetastatic breast cancer patients: A systematic review and meta-analysis.

Abstract

645 Background: Dose-dense chemotherapy (DDC) has become the standard of care in the adjuvant setting for women with high-risk breast cancer. We performed a systematic review and meta-analysis of existing data regarding the efficacy and toxicity of DDC approach in nonmetastatic breast cancer. Methods: Relevant RCT's were identified by searching The Cochrane Cancer network register of trials, The Cochrane Library, LILACS and MEDLINE (1.1966 and onwards). The terms adjuvant or neoadjuvant DDC and similar, breast cancer and similar where crossed. Two reviewers independently appraised the quality of trials and extracted data. Results: Eleven trials met the inclusion criteria and were classified into two categories. Three compared DDC to standard schedule. DDC showed superiority in overall survival (OS) and disease free survival (DFS) (HR 0.84; 95% CI 0.72 -0.98, p = 0.03 and HR 0.83 95% CI 0.73-0.94, p = 0.005). No benefit was observed in patients with positive hormonal receptor status. Six trials compared DDC with regimens using standard intervals, but the agents in the 2 arms were not similar nor their dosages. Similar results were obtained for these trials with improvement in OS (HR 0.85; 95% CI 0.75-0.96 p = 0.01) and DFS (HR 0.81; 95% CI 0.73-0.88 p = 0.0003) respectively. Toxicity evaluation depicted a higher non-hematological adverse events rate for DDC arms. One study was included in the systematic review only due to lack of any survival data. Conclusions: Current data indicate a favorable outcome for DDC in OS and DFS. Hormonal receptor status may play a role when using DDC. The acceptance of DDC as standard of care is based upon limited but encouraging data and warrants more randomized controlled trials to further validate this concept. No significant financial relationships to disclose.