Journal Article
. 2014 Nov;33(1).
doi: 10.1200/JCO.2014.56.3296.

SWOG S0221: a phase III trial comparing chemotherapy schedules in high-risk early-stage breast cancer

George T Budd 1 William E Barlow 2 Halle C F Moore 2 Timothy J Hobday 2 James A Stewart 2 Claudine Isaacs 2 Muhammad Salim 2 Jonathan K Cho 2 Kristine J Rinn 2 Kathy S Albain 2 Helen K Chew 2 Gary V Burton 2 Timothy D Moore 2 Gordan Srkalovic 2 Bradley A McGregor 2 Lawrence E Flaherty 2 Robert B Livingston 2 Danika L Lew 2 Julie R Gralow 2 Gabriel N Hortobagyi 2 
  • PMID: 25422488
  •     16 References
  •     34 citations


Purpose: To determine the optimal dose and schedule of anthracycline and taxane administration as adjuvant therapy for early-stage breast cancer.

Patients And Methods: A 2 × 2 factorial design was used to test two hypotheses: (1) that a novel continuous schedule of doxorubicin-cyclophosphamide was superior to six cycles of doxorubicin-cyclophosphamide once every 2 weeks and (2) that paclitaxel once per week was superior to six cycles of paclitaxel once every 2 weeks in patients with node-positive or high-risk node-negative early-stage breast cancer. With 3,250 patients, a disease-free survival (DFS) hazard ratio of 0.82 for each randomization could be detected with 90% power with two-sided α = .05. Overall survival (OS) was a secondary outcome.

Results: Interim analyses crossed the futility boundaries for demonstrating superiority of both once-per-week regimens and once-every-2-weeks regimens. After a median follow-up of 6 years, a significant interaction developed between the two randomization factors (DFS P = .024; OS P = .010) in the 2,716 patients randomly assigned in the original design, which precluded interpretation of the two factors separately. Comparing all four arms showed a significant difference in OS (P = .040) but not in DFS (P = .11), with all treatments given once every 2 weeks associated with the highest OS. This difference in OS seemed confined to patients with hormone receptor-negative/human epidermal growth factor receptor 2 (HER2) -negative tumors (P = .067), with no differences seen with hormone receptor-positive/HER2-negative (P = .90) or HER2-positive tumors (P = .40).

Conclusion: Patients achieved a similar DFS with any of these regimens. Subset analysis suggests the hypothesis that once-every-2-weeks dosing may be best for patients with hormone receptor-negative/HER2-negative tumors.

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