Two Commonly Used Paclitaxel Chemotherapy Schedules are Equally Effective for Early-Stage Breast Cancer, but One Has Fewer Side Effects

ASCO Annual Meeting
June 3, 2013

Women with higher-risk, early-stage breast cancer who received weekly chemotherapy with paclitaxel (Taxol) after surgery as part of a clinical trial lived for the same amount of time without the cancer returning as those who received higher doses of the same drug every two weeks (known as dose-dense therapy). However, the researchers found that the women who received chemotherapy every week experienced fewer and less serious treatment-related side effects.

Chemotherapy is the use of drugs to kill cancer cells, which work by stopping the cancer cells’ ability to grow and divide. Drugs like paclitaxel are often given after surgery for breast cancer to kill any cancer cells that may remain in the body. Paclitaxel is usually given to patients either weekly or every two weeks, at a higher dose. Although doctors currently use both treatment schedules, this is the first time researchers have looked at whether they have different results for patients.

To answer this question, more than 2,700 women with node-positive (cancer was found in the lymph nodes at diagnosis) or high-risk node-negative breast cancer that could be removed surgically first received treatment with one of three different schedules of two common chemotherapies, doxorubicin (Adriamycin) and cyclophosphamide (Neosar), and then received either a standard dose of paclitaxel every week for 12 weeks (12 treatments) or a higher dose every two weeks for 12 weeks (six treatments).

The researchers observed that the cancer in 82% of the women who received weekly chemotherapy and 81% of women who received chemotherapy every two weeks had not returned within five years. However, the women who received treatment every two weeks experienced more allergic reactions and greater muscle and bone pain compared with those who received treatment every week. Receiving treatment every two weeks also caused more neurologic toxicity, a common side effect involving numbness, tingling, and pain in the fingers and toes. This side effect potentially could be lessened or reduced by giving only four treatments as is the current practice rather than the six treatments that were given as part of this study.

What this means for patients

“Our results suggest that either treatment plan will have a good effect, but the weekly schedule seems to result in better quality of life for patients, causing less muscle and bone pain and allergic reactions,” said lead study author G. Thomas Budd, MD, a medical oncologist at the Cleveland Clinic in Ohio. “The findings provide assurance that women can choose the lower-dose therapy without sacrificing their chances of survival.” After a diagnosis of cancer, patients and their families must make a number of decisions about cancer treatment, some of which are more difficult than others. Take time to learn about your treatment options and be sure to ask questions about anything that is unclear.

Questions to Ask Your Doctor

  • What type of chemotherapy do you recommend? Why?
  • How often will I need to have treatment? For how long?
  • How will the treatment be given?
  • How will chemotherapy affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • What are the potential side effects of this treatment? What can be done to prevent or manage these side effects?

For More Information

Guide to Breast Cancer

Understanding Chemotherapy

Side Effects of Chemotherapy

Managing Side Effects