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Intense Chemotherapy Is Not Significantly Better Than Standard Chemotherapy

A type of more frequent chemotherapy in which women receive treatment every two weeks isn’t significantly better than traditional chemotherapy, according to a recent study published in the Journal of the American Medical Association.

The study, conducted by Swedish researchers, involved more than 2,000 women age 65 and younger who had undergone surgery for nonmetastatic node-positive or high-risk node-negative breast cancer at 86 sites in Sweden, Germany and Austria between 2007 and 2011. The women were randomly assigned to either four cycles of a more frequent form of chemotherapy, known as dose-dense chemotherapy, or to standard chemotherapy. The dose-dense group underwent treatment every two weeks with three specific drugs followed by four cycles of tailored additional dose-dense treatment with the chemotherapy drug docetaxel. The standard group received treatment with two different chemotherapy drugs every three weeks followed by three cycles of docetaxel every three weeks.

In dose-dense chemotherapy, the treatment intervals are shorter but the dosage remains the same, which some experts believe increases the treatment’s effectiveness for patients with early-stage breast cancer. However, the study’s researchers found that the benefits of dose-dense chemotherapy over standard chemotherapy were minimal. There was little difference in overall survival and recurrence-free survival in patients after five years, and the dose-dense group also didn’t have significantly better rates of avoiding cancer in the opposite breast, other malignant masses, breast cancer relapse or death from any other cause (87 percent in the dose-dense group vs. 82 percent in the standard group). About 89 percent of the dose-dense group compared to 85 percent of the standard group also didn’t have a recurrence of cancer after five years.

The Advantages & Disadvantages of Dose-Dense Chemotherapy

Though dose-dense chemotherapy showed no statistically significant improvement over standard chemotherapy in this study, other research has indicated it does have clear benefits for women with early-stage breast cancer. One study presented last year at the 2016 European Breast Cancer Conference found that dose-dense treatment led to increased survival rates in premenopausal women with early-stage breast cancer who had a high risk of their cancer returning. Other experts say dose-dense chemotherapy may be better for women with triple-negative breast cancer, an aggressive form of the disease that is more likely to return.

The study’s findings indicate dose-dense chemotherapy may not be suitable for every patient, which I agree with. There is a sub-population of breast cancer patients, such as those with triple-negative breast cancer, that benefit from this treatment. The advantages of this treatment are that patients complete treatment more quickly, but the major disadvantage is that treatment is more intense and you don’t really get a break. Therefore, it’s not meant for patients who aren’t in very good shape. Dose-dense chemotherapy is really intended for patients who will be able to tolerate it, so we typically offer it to younger, healthier people. Dose-dense chemotherapy always has to be administered with white cell growth-factor support since this treatment may lead to reduced white blood cell counts.

Some patients may be able to go through dose-dense treatment without any issues, but it really depends on the individual. Dose-dense chemotherapy also is a very specific regimen of breast cancer treatment; it’s not something that can be done for every regimen of breast cancer, which involves the drugs we use to treat patients, their dosage, frequency and the length of the treatment period. What this study shows is that it’s important for doctors to tailor treatment based on individual patients — and not necessarily a standard.