Treatment of locally advanced breast cancer

Deepu Mirchandani; Kamal Haider; Haji Chalchal

doi:10.1503/cmaj.1040624

We would like to raise another issue related to adjuvant chemotherapy for the treatment of women with locally advanced breast cancer.1 For adjuvant therapy of patients with node-positive, operable breast cancer, cross-trial comparison over similar follow-up periods has indicated a greater risk of acute leukemia with more anthracyclines and alkylators. Specifically, among patients treated with 4 cycles of adriamycin and cyclophosphamide (AC) followed by 4 cycles of paclitaxel, the incidence of acute leukemia ranged from 0.25% over a 69-month follow-up period2 to 0.18% over a 36-month follow-up period.3 For regimes of 6 cycles of anthracyclines and alkylating agents, the risk of acute leukemia was much greater: 1.42% over 59 months with cyclophosphamide, epirubicin and fluorouracil (CEF)4 and 1.17% over 48 months with epirubicin and cyclophosphamide.5 Even as therapy with AC followed by paclitaxel is being compared with a CEF regimen in the randomized phase III MA.21 trial (being conducted by the Clinical Trials Group of the National Cancer Institute of Canada), this side effect profile should not be ignored in discussions of adjuvant chemotherapy.

Given these data, the use of taxanes should be covered in clinical guideline development.

Deepu Mirchandani Kamal Haider Haji Chalchal Saskatoon Cancer Center Allan Blair Cancer Center Saskatoon, Sask.

Footnotes

Competing interests: None declared.

References

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