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37,000 Patient Meta-Analyses Confirms Benefit of Dose Dense Therapy for Treatment of Early Stage Breast Cancer

According to the National Cancer Institute the overall results of studies designed to compare dose dense therapy to every 3 week therapy support the use of dose-dense chemotherapy for the treatment of women with HER2-negative early stage breast cancer (ESBC).(1)

In the United States “dose dense” chemotherapy is considered standard of care for the treatment of women with ESBC. Adoption of this approach has lagged in some parts of the US and elsewhere in the world.

British physicians from the Early Breast Cancer Trialists Collaborative Group have now published a report in the April 2019 Lancet medical evaluating the outcomes of 37,000 women who participated in 26 clinical trials evaluating dose dense and standard dose chemotherapy.

The current analysis was designed to further determine if increasing the dose intensity of chemotherapy (the amount of drug delivered per unit time), was more effective at lowering breast cancer recurrence and death rates than standard schedule chemotherapy regimens.

One way to increase dose intensity is to use the same chemotherapy agents at the same doses but administer treatment every two weeks instead of every three weeks. The average weekly dose is therefore 50% higher with 2-weekly treatment than with the standard 3-weekly schedule comparator.

Another way of increasing the dose intensity of chemotherapy was to give the drugs individually in sequence rather than administering all the drugs together at the same time. This allows higher doses of the drugs to be used in each cycle while keeping the side effects manageable.

The researchers confirmed what several trials have already demonstrated; patients who received chemotherapy every two weeks were 17% less likely to have disease recurrence and 15% less likely to die from breast cancer within 10 years, compared with those who received treatment every three weeks.

The results apply to most women who are recommended chemotherapy for early-stage breast cancer. The reduction in recurrence with dose-intense chemotherapy across all trials was similar in estrogen receptor (ER) positive and in ER-negative disease and did not differ significantly by any other characteristics.

Previous research demonstrated that standard chemotherapy schedules reduce the risk of death from early-stage breast cancer by about a third. The analyses confirmed once again the value of dose-intense chemotherapy and highlights that the overall risk of dying of breast cancer can be reduced by at least 40% when compared to no chemotherapy.

It is well known that some doctors administer chemotherapy every three weeks instead of every two weeks because of their concerns about side effects and “perceived” uncertainty about additional benefit form dose intensive therapy. The results of this study further demonstrate the inferiority of every 3 week chemotherapy. (1)

References:

  1. https://www.cancer.gov/types/breast/hp/breast-treatment-pdq#_1375
  2. https://news.cancerconnect.com/breast-cancer/dose-dense-intensive-chemotherapy-improves-survival-in-early-stage-breast-cancer-bbMWnP-LcUmYdvyd0HVR1Q/

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