Open AccessAdjuvant continuous metronomic adriamycin + cyclophosphamide followed by weekly nab‐paclitaxel for high‐risk early‐stage breast cancer
Author(s) -
Cho Eunpi,
Wu Qian,
Rubinstein Lena,
Linden Hannah,
Gralow Julie,
Specht Jennifer,
Gadi Vijayakrishna,
Ellis Georgiana
Publication year - 2018
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/tbj.13013
Subject(s) - medicine , neutropenia , breast cancer , febrile neutropenia , cyclophosphamide , adjuvant , dosing , pegfilgrastim , oncology , gastroenterology , chemotherapy , cancer
Many studies have sought to optimize the dosing schedule of adjuvant chemotherapy in early‐stage breast cancer. Here, we assessed the use of continuous metronomic weekly doxorubicin plus daily oral cyclophosphamide ( AC ) with continuous G‐ CSF growth factor support for 12 weeks followed by weekly nab‐paclitaxel ( nP ) for 12 weeks. A nonrandomized phase II clinical trial was designed to assess (1) DFS at 2 years, (2) dose delivered, (3) use of nP in the adjuvant setting, and (4) toxicities. The dosing of A was 24 mg/m2 IV weekly and C was 60 mg/m2 oral daily (with scheduled filgrastim 5mcg/kg 6 days/week); nP , 100 mg/m2 IV weekly. For patients with HER 2 + disease, trastuzumab was started during the nP portion of therapy and continued for 12 months. Sixty patients enrolled with a median follow‐up of 6 years. Node‐positive disease was present in 58% of patients. Receptor categories included hormone receptor positive/ HER 2 negative (n = 25; 42%); triple negative (n = 19; 32%); or HER 2 positive (n = 16; 27%). DFS at 2 years was 93%. Mean dose delivered was greater than 90% for metronomic AC and 88% for nP . Treatment was well tolerated with a 2% incidence of febrile neutropenia. Continuous metronomic AC followed by nP was well tolerated in our patients with comparable DFS to historical controls.