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Superior outcome after neoadjuvant chemotherapy with docetaxel, anthracycline, and cyclophosphamide versus docetaxel plus cyclophosphamide: results from the NATT trial in triple negative or HER2 positive breast cancer

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Abstract

The purpose of this study is to evaluate the efficacy and safety of docetaxel plus cyclophosphamide (TC) compared with docetaxel, anthracycline, and cyclophosphamide (TEC) in neoadjuvant treatment of triple negative or HER2 positive breast cancer. Eligible breast cancer patients were randomized to receive six cycles of TC or TEC. The primary end point was pathological complete remission (pCR). Secondary end points included safety, clinical response rate, and survival outcome. One hundred and two patients were initially randomized and 96 patients were available for efficacy analysis. 96.9 % patients were treated with epirubicin as an anthracycline agent. pCR rates were 6.8 % (3/45) and 17.6 % (9/51) in TC and TEC group, respectively, P = 0.113. After a mean follow up of 20 (3–36) months, non-anthracycline-containing TC regimen treatment resulted in a worse event-free survival (adjusted hazard ratio [HR] 2.42; 95 % CI 1.11–5.30) and disease-free survival (HR 2.85; 95 % CI 1.21–6.74) compared with TEC regimen, which was more apparent in triple negative subtype. Severe adverse event rates were similar, except that patients treated with TEC had a higher rate of neutropenia and leucopenia. TEC treatment had a superior survival outcome and trend of higher pCR rate compared with TC in this trial setting, especially in triple negative subtype, which deserves further validation.

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Acknowledgments

The authors thank all patients and family members for their willingness to enter into this study. The authors acknowledge the following investigators who enrolled patients for this study from China: Yuechu Dai (Zhejiang), Xiaohua Zhang (Zhejiang), Huifang Hu (Jiangsu), Dedian Chen (Yunnan), Hongwei Zhang (Shanghai), Xiaodong Wang (Jiangsu), Jianjun He (Shanxi), Quchang Ouyang (Hunan), Weili Wu (Zhejiang), Anqin Zhang (Guangdong), Qing Shao (Jiangsu), Hui Song (Shanghai), Qi He (Shanghai), Yu Guo (Zhejiang), and Lili Tang (Hunan).

Conflict of interest

All authors have declared no conflicts of interest.

Funding

This research was supported in part by the grants from the National Natural Science Foundation of China (Grant Number: 81202087; 81172520; 81202088), Young Natural Science Foundation of Shanghai Municipal Science and Technology Commission (Grant Number: 12ZR1446400; 12140901503), and Sanofi.

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Authors and Affiliations

  1. Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China

    Xiaosong Chen & Kunwei Shen

  2. Department of Breast Surgery, The First People’s Hospital of Foshan, Foshan, Guangdong, China

    Guolin Ye

  3. Department of Breast Surgery, Guangzhou General Hospital of Guangzhou Military Area, Guangzhou, Guangdong, China

    Chenfang Zhang

  4. Department of Breast Surgery, Shanxi Provincial Cancer Hospital, Taiyuan, Shanxi, China

    Xinzheng Li

  5. Department of Breast Surgery, Obstetrics and Gynecology Hospital Affiliated to Zhejiang University, Hangzhou, Zhejiang, China

    Yiding Chen

  6. Department of Breast Surgery, Zhejiang Traditional Chinese Medical Hospital, Hangzhou, Zhejiang, China

    Xiaohong Xie

  7. Department of Breast Surgery, West China Hospital Sichuan University, Chengdu, Sichuan, China

    Hong Zheng

  8. Department of Breast Surgery, The Third Hospital of Nanchang, Nanchang, Jiangxi, China

    Yali Cao

  9. Department of Breast Surgery, Xin Hua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Kejin Wu

  10. Department of Breast Surgery, Xinjiang Uygur Autonomous Region Cancer Hospital, Xinjiang, China

    Duo Ni

  11. Department of Breast Surgery, Jiangsu Cancer Hospital, Nanjing, Jiangsu, China

    Jinhai Tang

  12. Department of Breast and Thyroid Surgery, Linyi People’s Hospital, Linyi, Shandong, China

    Ziguo Wei

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  1. Xiaosong Chen
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  2. Guolin Ye
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  3. Chenfang Zhang
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  13. Kunwei Shen
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Corresponding author

Correspondence to Kunwei Shen.

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This study was conducted on behalf of the NATT trial investigators

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Chen, X., Ye, G., Zhang, C. et al. Superior outcome after neoadjuvant chemotherapy with docetaxel, anthracycline, and cyclophosphamide versus docetaxel plus cyclophosphamide: results from the NATT trial in triple negative or HER2 positive breast cancer. Breast Cancer Res Treat 142, 549–558 (2013). https://doi.org/10.1007/s10549-013-2761-1

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  • DOI: https://doi.org/10.1007/s10549-013-2761-1

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