Abstract
BackgroundDose-dense chemotherapy is a widely accepted regimen for high-risk breast cancer patients. However, conflicting survival benefits of pure dose-dense chemotherapy have been reported in different randomized controlled trials (RCTs). This meta-analysis aimed to further assess the efficacy and safety of pure dose-dense chemotherapy in breast cancer.MethodsA literature search of electronic databases and websites was performed to identify phase III RCTs reporting the efficacy and toxicity of pure dose-dense chemotherapy. The endpoints of interest were overall survival (OS), disease-free survival (DFS), and toxicities. The hazard ratios (HRs) of death and recurrence and the odds ratios (ORs) of adverse events were estimated and pooled.ResultsSeven studies (five trials) were eligible, encompassing a total of 9851 patients. Patients treated with dose-dense chemotherapy obtained better DFS (HR = 0.83; 95% CI 0.75–0.91; p = 0.0001) than those treated with the conventional schedule, while OS benefit of dose-dense chemotherapy was less impressive (HR = 0.86; 95% CI 0.73–1.02; p = 0.08). However, significant OS benefit was observed in node-positive patients (HR = 0.77; 95% CI 0.66–0.90; p = 0.001). The incidence of anemia, pain, and transaminase elevation was higher in the dose-dense chemotherapy arm.ConclusionsDose-dense chemotherapy leads to better prognosis; these findings suggest that it may be a potentially preferred treatment for breast cancer patients, particularly for women with lymph node involvement. However, more RCTs are warranted to better define the best candidates for dose-dense chemotherapy.
Highlights
Dose-dense chemotherapy is a widely accepted regimen for high-risk breast cancer patients
Adjuvant chemotherapy confers about a one-third reduction for 10-year risk of death from breast cancer [2], a large number of patients will suffer from recurrence and breast cancer-related death
Gallen International Breast Cancer Consensus in 2017 [6], there were no clear recommendations for dose-dense chemotherapy, and less than half of the attendees thought that dose-dense regimens should be preferred in triple-negative patients
Summary
Dose-dense chemotherapy is a widely accepted regimen for high-risk breast cancer patients. Conflicting survival benefits of pure dose-dense chemotherapy have been reported in different randomized controlled trials (RCTs). This meta-analysis aimed to further assess the efficacy and safety of pure dosedense chemotherapy in breast cancer. To further optimize prognoses of breast cancer patients with elevated recurrence risk, different approaches have been taken to improve the efficacy of chemotherapy, including the addition of new drugs or modifications of drug delivery. Dose-dense chemotherapy, in which drugs are delivered with shorter interval between treatments, is a widely accepted regimen for high-risk breast cancer patients [5]. The few existing studies based on pure dose-dense chemotherapy, in which
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