Report in English with a Dutch summary (KCE reports 63A)

82 Breast Cancer KCE reports 63
Chemotherapy for invasive breast cancer.
Study ID Ref Search
date
Anthracycline-based regimens
Arriagada 2005 [82] 311 high risk N0
premenopausal
women
835 high risk
postmenopausal
women
Hutchins 2005 [83] Women with T1 to
T3a node negative
invasive
adenocarcinoma
Poole 2006 [182] Early breast cancer
(T1-3)
(n= 2391)
Population Intervention Outcomes Results Comments Study
type
No adjuvant
chemotherapy (n = 573)
vs. 6 courses of
anthracycline-based
chemotherapy (FAC or
FEC) (n = 573)
CMF (cyclophosphamide,
methotrexate and
fluorouracil) vs. CAF
(cyclophosphamide,
doxorubicin and
fluroruracil) with or
without tamoxifen (TAM)
NEAT:
4 cycles of epirubicin
followed by 4 cycles of
CMF
versus 6 cycles of CMF
alone
BR9601
4 cycles of epirubicin
followed by 4 cycles of
CMF
versus 8 cycles of CMF
alone
10-year survival
10-year distant
metastasis
10 year local
recurrence rates
Disease free
survival (DFS)
Overall survival
(OS)
Disease free
survival (DFS)
Overall survival
(OS)
Survival: 60% in control group and 65% in CT
group): p = 0.01
Metas: 28% (control) and 23% (CT group): p
= 0.02
Local rec: 12% (control) and 10% (CT
group): p= 0.024
Chemotherapy was significantly less effective
in post menopausal women with estrogen
receptor tumors.
After up to 10 years of follow-up, deferring
radiotherapy after chemotherapy did not
compromise local control
Ten years estimates indicated that CAF was
not significantly better than CMF for DFS.
Slight effect of CAF on OS (IC 0.99 to 1.43)
Greater toxicity of CAF
Epirubicin + CMF is superior to CMF alone
as adjuvant treatment
Randomization after
primary surgery
In post menop women: + at
least 2 years tamoxifen
Combined results of 2
RCTs
Combined two studies
RCTs
RCT High
RCT High
Level of
evidence
High