PDF herunterladen
CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2017; 38(01): 18-21
DOI: 10.4103/0971-5851.203498
Original Article

Taxane Combination Chemotherapy in Breast Cancer: Experience from a Tertiary Cancer Centre in India

Jyoti Bajpai
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Deepa Susan
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Vijay Patil
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Reena Nair
Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
,
Jaya Ghosh
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
R A Badwe
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Sudeep Gupta
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
› Institutsangaben Financial support and sponsorship Nil.
› Weitere Informationen
Auch verfügbar auf
  als PDF herunterladen Lizenzen und Reprints

Abstract

Aims:Docetaxel, Doxorubicin, Cyclophosphamide (TAC) is an intensive chemotherapy regimen; however, being highly myelosuppressive, its usage is limited in developing countries and hence merits exploration for feasibility and efficacy. Materials and Methods: This was a retrospective audit of medical records of breast cancer patients receiving TAC chemotherapy) from 2004 to 2008. Demographic details, toxicity, and outcome analysis were carried out. Results: A total of 133 patients (126 in [neo] adjuvant and 7 in metastatic setting) received TAC chemotherapy. The median age was 45 (21–67) years; 31% had coexisting diabetes and 12% hypertension. The delivered dose intensity was 94%. Discontinuation rate was 21/133 (15.8%) and the most common reason was hematological toxicity. There were 43 (32%) cases of febrile neutropenia and 2 (1.5%) Grade III thrombocytopenia with 3 (2%) toxic deaths. Grade III gastrointestinal toxicity (diarrhea) occurred in 35 (26%) and cardiac toxicity (congestive cardiac failure) in 2 (1.5%) patients. On univariate analysis, none of the variables (baseline serum albumin, hemoglobin, disease stage, or age) was found significant for chemotoxicity. At a median follow-up of 27 months (0.13–71.30 months), the estimated median disease-free survival (DFS) was 52 months in locally advanced group; however, the early breast cancer cohort has not reached to median DFS. Conclusions: TAC is an effective regimen but has significant toxicity despite the use of primary prophylactic Granulocyte Colony-Stimulating-Factor (G-GSF), including a small possibility of death. It can be considered “practically feasible” regimen in the adjuvant setting in carefully selected, fit patients.

Keywords

Breast cancer - developing countries - feasibility - TAC regimen


Publikationsverlauf

Artikel online veröffentlicht:
06. Juli 2021

© 2017. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Agarwal G, Ramakant P. Breast cancer care in India: The current scenario and the challenges for the future. Breast Care (Basel) 2008;3:21-7.
  • 2 Leong SP, Shen ZZ, Liu TJ, Agarwal G, Tajima T, Paik NS, et al. Is breast cancer the same disease in Asian and Western countries? World J Surg 2010;34:2308-24.
  • 3 Okonkwo QL, Draisma G, der Kinderen A, Brown ML, de Koning HJ. Breast cancer screening policies in developing countries: A cost-effectiveness analysis for India. J Natl Cancer Inst 2008;100:1290-300.
  • 4 Campone M, Fumoleau P, Bourbouloux E, Kerbrat P, Roché H. Taxanes in adjuvant breast cancer setting: Which standard in Europe? Crit Rev Oncol Hematol 2005;55:167-75.
  • 5 De Laurentiis M, Cancello G, D'Agostino D, Giuliano M, Giordano A, Montagna E, et al. Taxane-based combinations as adjuvant chemotherapy of early breast cancer: A meta-analysis of randomized trials. J Clin Oncol 2008;26:44-53.
  • 6 Martin M, Pienkowski T, Mackey J, Pawlicki M, Guastalla JP, Weaver C, et al. Adjuvant docetaxel for node-positive breast cancer. N Engl J Med 2005;352:2302-13.
  • 7 von Minckwitz G, Kümmel S, Vogel P, Hanusch C, Eidtmann H, Hilfrich J, et al. Intensified neoadjuvant chemotherapy in early-responding breast cancer: Phase III randomized GeparTrio study. J Natl Cancer Inst 2008;100:552-62.
  • 8 Martín M, Lluch A, Seguí MA, Ruiz A, Ramos M, Adrover E, et al. Toxicity and health-related quality of life in breast cancer patients receiving adjuvant docetaxel, doxorubicin, cyclophosphamide (TAC) or 5-fluorouracil, doxorubicin and cyclophosphamide (FAC): Impact of adding primary prophylactic granulocyte-colony stimulating factor to the TAC regimen. Ann Oncol 2006;17:1205-12.
  • 9 von Minckwitz G, Kümmel S, du Bois A, Eiermann W, Eidtmann H, Gerber B, et al. Pegfilgrastim +/- ciprofloxacin for primary prophylaxis with TAC (docetaxel/doxorubicin/cyclophosphamide) chemotherapy for breast cancer. Results from the GEPARTRIO study. Ann Oncol 2008;19:292-8.
  • 10 HD Woo HK, Lee JH, Kim HM, Han SW, Kim SY, Lim CW, et al. Toxicity and Tolerability Study of Adjuvant TAC Regimen Chemotherapy in Korean Patients with Breast Cancer. J Breast Cancer 2011;14(S):S44-9.
  • 11 O'Donnell PH, Dolan ME. Cancer pharmacoethnicity: Ethnic differences in susceptibility to the effects of chemotherapy. Clin Cancer Res 2009;15:4806-14.
  • 12 Common Terminology Criteria for Adverse Events (CTCAE) Version 4.02 U.S. Department Of Health And Human Services National Institutes of Health National Cancer Institute.
  • 13 Martín M1, Lluch A, Seguí MA, Ruiz A, Ramos M, Adrover E, et al. Toxicity and health-related quality of life in breast cancer patients receiving adjuvant docetaxel, doxorubicin, cyclophosphamide (TAC) or 5-fluorouracil, doxorubicin and cyclophosphamide (FAC): impact of adding primary prophylactic granulocyte-colony stimulating factor to the TAC regimen. Ann Oncol. 2006;17:1205-12.
  • 14 Margolin S, Bengtsson NO, Carlsson L, Edlund P, Hellstrøm M, Karlsson P, et al. Arandomised feasibility/phase II study (SBG 2004-1) with dose-dense/tailored epirubicin, cyclophoshamide (EC) followed by docetaxel (T) or fixed dosed dose-dense EC/T versus T, doxorubicin and C (TAC) in node-positive breast cancer. Acta Oncol 2011;50:35-41.
  • 15 Eiermann W, Pienkowski T, Crown J, Sadeghi S, Martin M, Chan A, et al. Phase III study of doxorubicin/cyclophosphamide with concomitant versus sequential docetaxel as adjuvant treatment in patients with human epidermal growth factor receptor 2-normal, node-positive breast cancer: BCIRG-005 trial. J Clin Oncol 2011;29:3877-84.
  • 16 Hor SY, Lee SC, Wong CI, Lim YW, Lim RC, Wang LZ, et al. PXR, CAR and HNF4alpha genotypes and their association with pharmacokinetics and pharmacodynamics of docetaxel and doxorubicin in Asian patients. Pharmacogenomics J 2008;8:139-46.
  • 17 Lal S, Wong ZW, Jada SR, Xiang X, Chen Shu X, Ang PC, et al. Novel SLC22A16 polymorphisms and influence on doxorubicin pharmacokinetics in Asian breast cancer patients. Pharmacogenomics 2007;8:567-75.
  • 18 Sandanaraj E, Lal S, Selvarajan V, Ooi LL, Wong ZW, Wong NS, et al. PXR pharmacogenetics: Association of haplotypes with hepatic CYP3A4 and ABCB1 messenger RNA expression and doxorubicin clearance in Asian breast cancer patients. Clin Cancer Res 2008;14:7116-26.
  • 19 Tan SH, Lee SC, Goh BC, Wong J. Pharmacogenetics in breast cancer therapy. Clin Cancer Res 2008;14:8027-41.
  • 20 Afsar NA, Ufer M, Haenisch S, Remmler C, Mateen A, Usman A, et al. Relationship of drug metabolizing enzyme genotype to plasma levels as well as myelotoxicity of cyclophosphamide in breast cancer patients. Eur J Clin Pharmacol 2012;68:389-95.