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The Safety of Dose-Dense Doxorubicin and Cyclophosphamide Followed by Paclitaxel With Trastuzumab in HER-2/neu Overexpressed/Amplified Breast Cancer

Chau Dang, Monica Fornier, Steven Sugarman, Tiffany Troso-Sandoval, Diana Lake, Gabriella D'Andrea, Andrew Seidman, Nancy Sklarin, Maura Dickler, Violante Currie, Theresa Gilewski, Mary Ellen Moynahan, Pamela Drullinsky, Mark Robson, Carolyn Wasserheit-Leiblich, Nancy Mills, Richard Steingart, Katherine Panageas, Larry Norton, Clifford Hudis

From the Memorial Sloan-Kettering Cancer Center, Department of Medicine; Memorial Sloan-Kettering Cancer Center, Department of Biostatistics, New York, NY

Corresponding author: Chau Dang, MD, Memorial Sloan- Kettering Cancer Center, 1275 York Ave, Howard 713, New York, NY 10021; e-mail: dangc{at}mskcc.org

Purpose: Dose-dense (dd) doxorubicin and cyclophosphamide (AC) followed by paclitaxel (P) is superior to every 3-weekly AC followed by P. Given the demonstrated cardiac safety for trastuzuamb (T) with conventionally scheduled AC followed by P, we tested the safety of dd AC followed by P with T. The primary end point was cardiac safety, and the secondary end points were time to recurrence and overall survival.

Methods: Patients with HER-2/neu immunohistochemistry (IHC) 3+ or fluorescent in situ hybridization (FISH)-amplified breast cancer and baseline left ventricular ejection fraction (LVEF) of 55% were enrolled, regardless of tumor size or nodal status. Treatment consisted of AC (60/600 mg/m²) x 4 followed by P (175 mg/m²) x 4 every 2-weekly with pegfilgrastim (6 mg on day 2) + T x1 year. LVEF by radionuclide scan was obtained at baseline, at months 2, 6, 9, and 18.

Results: From January 2005 to November 2005, 70 patients were enrolled. The median age was 49 years (range, 27 to 72 years); median LVEF at baseline was 68% (range, 55% to 81%). At month 2 in 70 of 70 patients, the median LVEF was 67% (range, 58% to 79%); at month 6 in 67 of 70 patients, it was 66% (range, 52% to 75%); at month 9 in 68 of 70 patients, it was 65% (range, 50% to 75%); and at month 18 in 48 of 70 patients, it was 66% (range, 57% to 75%). As of December 1, 2007, the median follow-up was 28 months (range, 25 to 35 months). One patient (1%) experienced conestive heart failure (CHF). There were no cardiac deaths.

Conclusion: Dose-dense AC followed by P/T followed by T is feasible and is not likely to increase the incidence of cardiac events compared to established regimens.

Supported by Genentech and Amgen.

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

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• Weighing a Dose-Dense Option for Adjuvant Chemotherapy and Trastuzumab in Early-Stage Breast Cancer
  Erica L. Mayer and Harold J. Burstein
  JCO 2008 26: 1198-1200 [Full Text]

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				C. Dang, L. Norton, and C. Hudis Dose-Dense Chemotherapy With Trastuzumab Is an Appropriate Option J. Clin. Oncol., July 20, 2008; 26(21): 3655 - 3656. [Full Text] [PDF]