Tailored Dose-Dense Versus Standard Adjuvant Chemotherapy for High-Risk Early Breast Cancer: End-of-Study Results of the Randomized PANTHER Trial

• Published in: Journal of clinical oncology Vol. 42; no. 26; pp. 3077 - 3082
• Main Authors: Matikas, Alexios, Möbus, Volker, Greil, Richard, Andersson, Anne, Steger, Günther G, Untch, Michael, Fornander, Tommy, Malmström, Per, Schmatloch, Sabine, Johansson, Hemming, Hellström, Mats, Brandberg, Yvonne, Gnant, Michael, Loibl, Sibylle, Foukakis, Theodoros, Bergh, Jonas
• Format: Journal Article
• Language: English
• Published: United States 2024
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Cancer and Oncology; Cancer och onkologi; Chemotherapy, Adjuvant; Clinical Medicine; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Disease-Free Survival; Docetaxel - administration & dosage; Drug Administration Schedule; Epirubicin - administration & dosage; Female; Humans; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged
• ISSN: 0732-183X; 1527-7755; 1527-7755
• DOI: 10.1200/JCO.24.00178

JCO
.Although dose-dense adjuvant chemotherapy administered once every 2 weeks leads to superior outcomes compared with standard regimens once every 3 weeks, the observed improvement is largely limited to studies using the suboptimal paclitaxel schedule once every 3 weeks as control. PANTHER is an international phase III trial which compared sequential epirubicin/cyclophosphamide and docetaxel administered either once every 2 or once every 3 weeks, with tailored dosing at the dose-dense schedule according to hematologic toxicity. In this end-of-study analysis, the median follow-up was 10.3 years. Compared with standard adjuvant chemotherapy, dose-dense treatment improved breast cancer recurrence-free survival (hazard ratio [HR], 0.80 [95% CI, 0.65 to 0.98];
= .030), event-free survival (HR, 0.78 [95% CI, 0.65 to 0.94];
= .009), and distant disease-free survival (HR, 0.79 [95% CI, 0.64 to 0.98];
= .030) while the improvement in overall survival was not statistically significant (HR, 0.82 [95% CI, 0.65 to 1.04];
= .109). To our knowledge, this is the first trial that confirms the benefit of a dose-dense regimen over a control regimen containing docetaxel once every 3 weeks.