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Phase II Study of Docetaxel, Doxorubicin, and Cyclophosphamide as First-Line Chemotherapy for Metastatic Breast Cancer

From the Cross Cancer Institute, Edmonton; Tom Baker Cancer Centre, Calgary, Alberta; Hôpital Sacré-Coeur de Montréal, Montréal, Québec; Saskatoon Cancer Centre, Saskatoon, Saskatchewan, Canada; and Aventis Pharma, Inc, Antony, France.

Address reprint requests to Jean-Marc Nabholtz, MD, Director, Cancer Therapy Development Program, University of California at Los Angeles, PUVB #3360B, 10945 Le Conte Ave, Los Angeles, CA 90095; email jean-marc.nabholtz{at}bcirg.com

PURPOSE: This pilot phase II study investigated the efficacy and toxicity of docetaxel with doxorubicin and cyclophosphamide (TAC) as first-line chemotherapy for anthracycline-naive patients with metastatic breast cancer.

PATIENTS AND METHODS: Fifty-four patients received a total of 359 courses consisting of docetaxel 75 mg/m² given intravenously (IV) over 1 hour, preceded by IV doxorubicin 50 mg/m² and cyclophosphamide 500 mg/m² for a maximum of eight 3-week cycles.

RESULTS: After an independent panel review, the overall objective response rate was 77% (complete response, 6%). Overall objective response rates in patients with visceral, bone, and liver involvement were 82%, 82%, and 80%, respectively. Median duration of response was 52 weeks, and median time to progression was 42 weeks. With a median follow-up of 32 months, the median survival had not yet been reached, whereas the 2-year survival was 57%. The main toxicities were hematologic (neutropenia grade 3/4 in 100% of patients and 95% of cycles; febrile neutropenia in 34% of patients and 9% of cycles). Documented grade 3 infection was seen in one patient (2%) in one cycle, and no toxic death was reported. Severe acute or chronic nonhematologic adverse events were infrequent, and docetaxel-specific toxicities (such as fluid retention and nail changes) were mild, with only one patient being discontinued for fluid retention. Congestive heart failure was seen in two patients (4%).

CONCLUSION: TAC is an active and manageable regimen that has been chosen as the basis of five randomized phase III trials, including two pivotal studies comparing TAC to fluorouracil plus doxorubicin and cyclophosphamide in the metastatic and adjuvant treatment of breast cancer.

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