Abstract
The aims of this study were to investigate the impact of the relative dose intensity (RDI) of chemotherapy on disease-free survival (DFS) and overall survival (OS), to identify the optimal RDI cut-off points with the docetaxel, epirubicin and cyclophosphamide (TEC) regimen for stage I–III breast cancer patients and to explore the adverse events in these patients. To achieve this, we performed a retrospective analysis of breast cancer patients treated at the First Affiliated Hospital of Chongqing Medical University in 2011. The results showed that among 293 patients with the TEC regimen, 85% and 80% were the cut-off points at which a high RDI was associated with better overall survival (HR = 2.04; 95% CI 1.13, 3.70; p = 0.02) and disease-free survival (HR = 1.97; 95% CI 1.14–3.42; p = 0.02), respectively. Among 169 HR(+) patients, 80% was the cut-off point for DFS (HR = 2.33; 95% CI 1.07–5.08; p = 0.03), and 85% was the cut-off point for OS (HR = 3.00; 95% CI 1.24–7.26; p = 0.02). Among 105 HR(−) patients, 80% was the cut-off point for OS (HR = 2.86; 95% CI 1.05–7.80; p = 0.04). Of 293 patients, neutropenia, nausea, and vomiting were found to be correlated with the level of RDI. In conclusion, a higher RDI of chemotherapy is associated with better survival but with a higher probability of causing adverse events. To optimize survival benefits, the RDI should be maintained ≥ 85% for HR(+) patients and ≥ 80% for HR(−) patients.
Highlights
The current standard of care for breast cancer includes breast surgery, local radiation therapy, systemic adjuvant and neoadjuvant chemotherapy, endocrine therapy and target therapy
Outof a total of 503 breast cancer patients, 293 (52% received neochemotherapy) who were treated with TEC regimen and had both case and follow-up records available were included in this study
Our study investigated the TEC regimen-specific cut-off points of Relative dose intensity (RDI)
Summary
The current standard of care for breast cancer includes breast surgery, local radiation therapy, systemic adjuvant and neoadjuvant chemotherapy, endocrine therapy and target therapy. These trials were based on first-generation regimens such as cyclophosphamide, methotrexate and 5-fluorouracil (CMF) and patients from Western countries, and the optimal cut-off point of the RDI for the new generation of chemotherapy regimens in clinical practice and for Chinese patients is unknown. It is not certain whether high-dose chemotherapy will achieve the maximum benefit It is unknown if 85% remains the optimal cut-off point of RDI for anthracyclines combined with taxane regimens in the current clinical practice. Our study aimed to (1) investigate the impact of chemotherapy (combined neoadjuvant and adjuvant chemotherapies) RDI on disease-free and overall survival with a regimen containing anthracycline and taxane; (2) identify the optimal RDI cut-off points; and (3) investigate the adverse events of maintaining a high RDI compared with a low RDI for stage I–III breast cancer
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