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You are here: Home: BCU 3|2001: Section 2
Section 2
Is
Four Cycles of AC Adequate Adjuvant Chemotherapy?
The 1995 overview established that anthracycline-containing
regimens added benefit, but the choice of a specific regimen is
also an issue. My reading of the literature is that we were too
hasty in adopting four cycles of AC as a standard, and it was based
more on convenience than true superiority over the previous standard,
which was CMF. In fact, there are no convincing data that AC times
four is superior to CMF.
On the other hand, if you look at the overview of randomized trials,
with and without anthracyclines, there is superiority in favor of
the anthracyclines. Most of that comes from three-drug regimens.
And you can interpret that as either the contribution of 5-fluorouracil
— which is usually the third drug — or the contribution
of duration of therapy. Most of the three-drug combinations have
been administered for six cycles, as opposed to the AC or EC regimens,
which were given mostly for four cycles. In the adjuvant setting,
one should try to use what has — at least on the basis of controlled
trials — given the best results. In this case, I think we have
compromised instead of going for the best.
I do not have
incontrovertible proof that my hypothesis is completely correct,
but I think there is more evidence on this side than on the other.
And if you read the original NSABP B-15 paper that compared AC versus
CMF, it is clear that the reason for recommending adoption of AC
is simply one of convenience. I have stated this in public, including
at the NIH Consensus Development Conference, although I was unsuccessful
in making this sufficiently clear to the panel to sway their opinion.
The Canadians are pursuing a clinical trial that will go to the
heart of this matter by comparing FEC versus EC/Taxol versus AC/Taxol.
—
Gabriel Hortobagyi, MD
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NIN
CONSENSUS DEVELOPMENT CONFERENCE ON EARLY BREAST CANCER, FINAL
STATEMENT FULL
TEXT
…Available
data indicate that adjuvant chemotherapy regimens that include
an anthracycline result in a small but statistically significant
improvement in survival compared to nonanthracycline-containing
programs.
…Randomized trials have demonstrated threshold dose effects
for two of the most active chemotherapeutic agents, doxorubicin
(A) and cyclophosphamide (C). These two drugs are frequently
administered together (AC) and appear to result in a comparable
survival outcome, whether given preoperatively or postoperatively.
However, AC has not been compared to cyclophosphamide/doxorubicin/5-fluorouracil
(CAF) or cyclophosphamide/epirubicin/5-fluorouracil (CEF).
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SELECT
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