Discussion
gastrointestinal tract toxic, death, Leukemia, leukopenia, breast cancer, neutropenia, fatigue, anemia, cardiotoxic, neurotoxic, hepatotoxic, myelosuppression, alopecia, Cancer
GROUP B, LEUKEMIA, BREAST CANCER, LEUKOPENIA, NEUTROPENIA, THROMBOCYTOPENIA, ANEMIA, ADVERSE EFFECTS, LUMINAL B BREAST CANCER, EVENTS, ALOPECIA, CANCER
This trial was designed to determine whether the EP regimen is noninferior to the standard EC-P regimen in both efficacy and safety for Cyclophosphamide is an important component of most adjuvant chemotherapy regimens in breast cancer.The Cancer and Leukemia Group B (CALGB) 9741 trialIt seems that the differences in DFS and DDFS between the 2 groups are not reflected at all in the OS curve. Several reasons may account for it. First, OS is a parameter with all-cause death, which can be influenced by various factors. Although the relapse rate seems a little different in the 2 groups, further management is also crucial to affect OS. Second, DFS and DDFS are better in patients with luminal B breast cancer. With higher levels of Ki67, the patients with the luminal B subtype may have higher risk of relapse; therefore, those patients may benefit more from chemotherapy like the EP regimen.In the present study, subgroup analysis showed that the EP group had a better DFS than the EC-P group among postmenopausal women and patients without radiotherapy. These results indicate that the EP regimen may be more suitable for postmenopausal women and patients who are unable to receive radiotherapy. However, this discrepancy may have resulted from the higher dose of epirubicin and paclitaxel used in the EP regimen. Combined with the former studies,In addition, whether a sequential or concurrent regimen of anthracyclines and taxanes is superior for breast cancer is controversial. A recent meta-analysis detected that the sequential regimen of anthracyclines and taxanes for patients with operable breast cancer did not show a significant benefit in DFS or OS over the concurrent regimen.In this study, the patients in the EP group had more frequent toxic effect events than those in the EC-P group, including any grade of leukopenia, neutropenia, anemia, thrombocytopenia, gastrointestinal tract toxic effects, neurotoxic effects, hepatotoxic effects, cardiotoxic effects, alopecia, and fatigue. Grades 3 and 4 leukopenia and neutropenia also occurred more frequently in the EP group, likely because epirubicin and paclitaxel were administered concurrently during the same treatment period. Although the total dose of anthracyclines was increased, grades 3 and 4 cardiotoxic effects were not observed, and cardiotoxic effects were within a manageable range. Severe myelosuppression can be prevented by the administration of granulocyte colony-stimulating factor. Other severe adverse effects were also treated and managed, and no treatment-related death occurred in both groups during the treatment.In addition to the cyclophosphamide-free regimen, other studies