Final results of a randomized phase III trial comparing cyclophosphamide, epirubicin, and fluorouracil with a dose-intensified epirubicin and cyclophosphamide plus filgrastim as neoadjuvant treatment in locally advanced breast cancer: An EORTC-NCIC-SAKK multicenter study

Therasse, Patrick;Mauriac, L;Welnicka-Jaskiewicz, M;Bruning, P;Piccart, Martine;et.al.
(2003) Journal of Clinical Oncology — Vol. 21, n° 5, p. 843-850 (2003)

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  • Therasse, Patrick
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  • Mauriac, L
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  • Welnicka-Jaskiewicz, M
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  • Bruning, P
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  • Piccart, Martine
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Abstract
Purpose: To compare the efficacy of a standard anthrocycline-based regimen to a dose-intensified anthracycline regimen in locally advanced breast cancer. Patients and Methods., Locally advanced breast cancer patients were randomly assigned onto a study comparing cyclophosphamide (C; 75 mg/m(2) orally days 1 to 14), epirubicin (E; 60 mg/m(2) intravenously [IV] days 1, 8), and fluorouracil (F; 500 mg/m(2) IV days 1, 8) six cycles every 28 days versus E (1120 mg/m 2 IV day 1), C (830 mg/m(2) IV day 1), and granulocyte colony-stimulating factor (filgrastim; 5 mug/kg/d subcutaneously days 2 to 13) six cycles every 14 days. The study was designed to detect a 15% improvement, that is, from 50% to 65% in median progression-free survival (PFS) in favor of the dose-intensified regimen. Results: A total of 448 patients were enrolled over a period of 3 years. The median dose intensity delivered for C and E reached, respectively, 85% and 87% of that planned in the CEF arm and 96% and 95% of that planned in the EC arm. The dose-intensified arm was slightly more emetogenic and generated more grade 3 to 4 anemia but less febrile neutropenia episodes. After a median follow-up of 5.5 years, 277 events have been reported. The median PFS was 34 and 33.7 months for CEF and EC, respectively (P = .68), and the 5-year survival rate was 53% and 51% for CEF and EC, respectively (P = .94). Conclusion: Dose-intensified EC does not provide a measurable therapeutic benefit over CEF as neoadjuvant chemotherapy for unselected locally advanced breast cancer patients. (C) 2003 by American Society of Clinical Oncology.
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Therasse, P., Mauriac, L., Welnicka-Jaskiewicz, M., Bruning, P., Cufer, T., Bonnefoi, H., Tomiak, E., Pritchard, K., Hamilton, A., & Piccart, M. (2003). Final results of a randomized phase III trial comparing cyclophosphamide, epirubicin, and fluorouracil with a dose-intensified epirubicin and cyclophosphamide plus filgrastim as neoadjuvant treatment in locally advanced breast cancer: An EORTC-NCIC-SAKK multicenter study. Journal of Clinical Oncology, 21(5), 843-850. https://doi.org/10.1200/JCO.2003.05.135 (Original work published 2003)