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Abstract
Purpose
Recent randomized phase III trial by the Breast Cancer International Research Group (BCIRG 001) showed that docetaxel plus doxorubicin and cyclophosphamide (TAC) is superior to fluorouracil plus doxorubicin and cyclophosphamide (FAC) as adjuvant chemotherapy for node-positive operable breast cancer. Unfortunately, TAC was clearly more toxic than FAC not only with respect to neutropenic fever events, but also with respect to many extrahematological side effects. The aim of this study was to evaluate the toxicity and tolerability of Korean patients with breast cancer treated with TAC.
Methods
This study was conducted on 80 patients with breast cancer who underwent primary surgery at the Department of Surgery in Soonchunhyang University (4 affiliated hospitals) from October 2005 to October 2008. The patients received 480 courses consisting of TAC (75/50/500 mg/m2, every 3 weeks for 6 cycles) without prophylactic granulocyte colony-stimulating factor (G-CSF). Toxicity was graded according to the National Cancer Institute Common Toxicity Criteria version 3.0.
Results
The main toxicities were hematologic (neutropenia grade 3/4 in 98.8% of patients and 92.3% of cycles; febrile neutropenia in 42.5% of patients and 16.0% of cycles). No cases of septic death occurred. The peak time of occurrence for febrile neutropenia was 7-10 days after receiving chemotherapy (mean duration, 2.05 days). Severe nonhematologic adverse events were as follows: myalgia (30.0%), neurotoxicity (17.5%), fatigue (16.3%), stomatitis (12.5%), and nausea (11.3%).
Conclusion
An adjuvant TAC regimen without prophylactic G-CSF was tolerable in Korean patients with breast cancer. Although most of the patients developed neutropenia, the nonhematologic toxicities (cardiac toxicity) were tolerable. Further studies on prophylactic G-CSF use to assess the contribution to reduced hematologic toxicities are required in Korean patients with breast cancer.
Figures and Tables
Figure 1
Time of occurrence of grade 3/4 neutropenia and febrile neutropenia. (A) The peak time of occurrence of grade 3/4 neutropenia was 6-8 days after receiving chemotherapy. (B) The peak time of occurrence of febrile neutropenia was 7-10 days after receiving chemotherapy.
References
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