Efficacy and safety of dose-dense neoadjuvant chemotherapy with nab-paclitaxel followed by epirubicin and cyclophosphamide for operable breast cancer

Abstract Objective Dose-dense chemotherapy has shown a better prognosis than standard interval chemotherapy in adjuvant settings for high-risk breast cancer. This study aimed to evaluate the efficacy and safety of dose-dense nanoparticle albumin-bound paclitaxel followed by dose-dense epirubicin and...

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Published in:	Japanese journal of clinical oncology 2023-12, Vol.53 (12), p.1119-1124
Main Authors:	Matsumoto, Akiko, Jinno, Hiromitsu, Naruse, Saki, Isono, Yuka, Maeda, Yuka, Sato, Ayana, Yamada, Miki, Ikeda, Tatsuhiko, Sasajima, Yuko
Format:	Article
Language:	eng
Subjects:	Albumin-Bound Paclitaxel - therapeutic use Antineoplastic Combined Chemotherapy Protocols - adverse effects Breast Neoplasms - drug therapy Breast Neoplasms - pathology Breast Neoplasms - surgery Cyclophosphamide - adverse effects Epirubicin - adverse effects Female Humans Mastectomy Neoadjuvant Therapy Paclitaxel - adverse effects Treatment Outcome
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Summary:	Abstract Objective Dose-dense chemotherapy has shown a better prognosis than standard interval chemotherapy in adjuvant settings for high-risk breast cancer. This study aimed to evaluate the efficacy and safety of dose-dense nanoparticle albumin-bound paclitaxel followed by dose-dense epirubicin and cyclophosphamide as neoadjuvant chemotherapy for human epidermal growth factor 2 (HER2)-negative operable breast cancer. Methods Patients with histologically confirmed stage I–III HER2-negative breast cancer were enrolled in this study. Patients received nanoparticle albumin-bound paclitaxel (260 mg/m2) followed by epirubicin (90 mg/m2) and cyclophosphamide (600 mg/m2) every 2 weeks with pegfilgrastim. The primary endpoint was the pathological complete response rate. Patients also underwent prophylactic management for peripheral neuropathy, which involved a combination of cryotherapy, compression therapy using elastic stockings and medications including goshajinkigan. Results Among the 55 patients enrolled in this study, 13 (23.6%) achieved pathological complete response, of whom 10/26 (38.5%) patients had triple-negative disease and 3/29 (10.3%) had luminal disease. The objective response was observed in 46 (83.6%) patients. Of the 36 patients who were initially planned for mastectomy, 11 (30.6%) underwent breast-conserving surgery after neoadjuvant chemotherapy. The most common grade 3–4 adverse events were myalgia (14.5%), fatigue (12.7%) and elevated transaminase levels (9.1%). No patients experienced febrile neutropenia. Eight (14.5%) patients discontinued treatments due to adverse events. Conclusions Neoadjuvant dose-dense biweekly nanoparticle albumin-bound paclitaxel followed by dose-dense epirubicin and cyclophosphamide was effective, especially in patients with triple-negative disease, and feasible with pegfilgrastim support. Neoadjuvant DD biweekly nab-PTX followed by DD EC may be a good choice of treatment, especially for patients with TN breast cancer, and prophylactic pegfilgrastim could support DD chemotherapy.
ISSN:	1465-3621 1465-3621