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Randomized, Controlled Trial Investigating Short-Term Health-Related Quality of Life With Doxorubicin and Paclitaxel Versus Doxorubicin and Cyclophosphamide As First-Line Chemotherapy in Patients With Metastatic Breast Cancer: European Organization for Research and Treatment of Cancer Breast Cancer Group, Investigational Drug Branch for Breast Cancer and the New Drug Development Group Study

From the Quality of Life Unit, European Organization for Research and Treatment of Cancer Data Center, Insitut Jules Bordet, Brussels, Belgium; Institute of Oncology, Ljubljana, Slovenian; Weston Park Hospital, Sheffield; Newcastle General Hospital, Newcastle-upon-Tyne; and Cancer Research United Kingdom Department of Medical Oncology, Glasgow, United Kingdom; Instituto Regina Elena, Roma, Italy; and Centre Georges Francois Leclerc, Dijon Cedex, France

Address reprint requests to Andrew Bottomley, European Organization for Research and Treatment of Cancer Data Center, Quality of Life Unit, Ave Mounier, 83 Bte11, 1200 Brussels, Belgium; e-mail: abo{at}eortc.be

PURPOSE: To compare health-related quality of life (HRQOL) in patients with metastatic breast cancer receiving the combination of doxorubicin and paclitaxel (AT) or doxorubicin and cyclophosphamide (AC) as first-line chemotherapy treatment.

PATIENTS AND METHODS: Eligible patients (n = 275) with anthracycline-naive measurable metastatic breast cancer were randomly assigned to AT (doxorubicin 60 mg/m² as an intravenous bolus plus paclitaxel 175 mg/m² as a 3-hour infusion) or AC (doxorubicin 60 mg/m² plus cyclophosphamide 600 mg/m²) every 3 weeks for a maximum of six cycles. Dose escalation of paclitaxel (200 mg/m²) and cyclophosphamide (750 mg/m²) was planned at cycle 2 to reach equivalent myelosuppression in the two groups. HRQOL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 and the EORTC Breast Module at baseline and the start of cycles 2, 4, and 6, and 3 months after the last cycle.

RESULTS: Seventy-nine percent of the patients (n = 219) completed a baseline measure. However, there were no statistically significant differences in HRQOL between the two treatment groups. In both groups, selected aspects of HRQOL were impaired over time, with increased fatigue, although some clinically significant improvements in emotional functioning were seen, as well as a reduction in pain over time. Overall, global quality of life was maintained in both treatment groups.

CONCLUSION: This information is important when advising women patients of the expected HRQOL consequences of treatment regimens and should help clinicians and their patients make informed treatment decisions.

Supported by the Camilla Samuel Fellowship in Memory of Lady Grierson (F.E.). This trial was supported by Bristol-Myers Squibb, Waterloo, Belgium.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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