Epirubicin and docetaxel with or without capecitabine as neoadjuvant treatment for early breast cancer: final results of a randomized phase III study (ABCSG-24)
G G Steger, R Greil, A Lang, M Rudas, F Fitzal, B Mlineritsch, B L Hartmann, R Bartsch, E Melbinger, M Hubalek, H Stoeger, P Dubsky, S Ressler, A L Petzer, C F Singer, C Muss, R Jakesz, S P Gampenrieder, C C Zielinski, C Fesl, M Gnant, Austrian Breast and Colorectal Study Group (ABCSG), G G Steger, R Greil, A Lang, M Rudas, F Fitzal, B Mlineritsch, B L Hartmann, R Bartsch, E Melbinger, M Hubalek, H Stoeger, P Dubsky, S Ressler, A L Petzer, C F Singer, C Muss, R Jakesz, S P Gampenrieder, C C Zielinski, C Fesl, M Gnant, Austrian Breast and Colorectal Study Group (ABCSG)
Abstract
Background: This randomized phase III trial compared pathologic complete response (pCR) rates of early breast cancer (EBC) following neoadjuvant epirubicin-docetaxel (ED)±capecitabine (C), and evaluated the addition of trastuzumab in HER2-positive tumors.
Patients and methods: Patients with invasive breast cancer (except T4d) were randomly assigned to receive six 3-weekly cycles of ED (both 75 mg/m2)±C (1000 mg/m2, twice daily, days 1-14). Patients with HER2-positive disease were further randomized to receive trastuzumab (8 mg/kg, then 6 mg/kg every 3 weeks) or not. Primary end point: pCR rate at the time of surgery.
Results: Five hundred thirty-six patients were randomized to ED (n=266) or EDC (n=270); 93 patients were further randomized to trastuzumab (n=44) or not (n=49). pCR rate was significantly increased with EDC (23.0% versus 15.4% ED, P=0.027), and nonsignificantly further increased with trastuzumab (38.6% EDC versus 26.5% ED, P=0.212). Rates of axillary node involvement at surgery and breast conservation were improved with EDC versus ED, but not significantly; the addition of trastuzumab had no further impact. Hormone receptor status, tumor size, grade, and C (all P≤0.035) were independent prognostic factors for pCR. Trastuzumab added to ED±C significantly increased the number of serious adverse events (35 versus 18; P=0.020), mainly due to infusion-related reactions.
Conclusion: These findings show that the integration of C into a neoadjuvant taxane-/anthracycline-based regimen is a feasible, safe, and effective treatment option, with incorporation of trastuzumab in HER2-positive disease.
Clinical trial number: NCT00309556, www.clinicaltrials.gov.
Keywords: capecitabine; docetaxel; early breast cancer; epirubicin; neoadjuvant treatment.
Source: PubMed