Expert Point of View: Tiffany A. Traina, MD, and Larry Norton, MD


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As of today, anthracycline and taxane-based adjuvant regimens remain an appropriate choice for node-positive or high-risk, node-negative breast cancers. While not perfect, it’s highly encouraging to see how well this entire study population performed.
— Tiffany A. Traina, MD

Study discussant Tiffany A. Traina, MD, Clinical Director of the Breast Medicine Service and Associate Attending at Memorial Sloan Kettering Cancer Center and Assistant Professor of Medicine at Weill Cornell Medicine, commented, “The overall trial results demonstrate that not only is docetaxel plus cyclophosphamide not noninferior to taxane plus anthracycline in disease-free survival, but docetaxel plus cyclophosphamide × 6 is significantly inferior to the anthracycline and taxane-containing regimens in terms of disease-free survival.”

By preplanned stratification variables, including protocol, hormone-receptor status, and number of positive nodes, there were no significant differences in the treatment effect. Subset analyses should be interpreted with caution, she warned.

“As of today, anthracycline and taxane-based adjuvant regimens remain an appropriate choice for node-positive or high-risk, node-negative breast cancers. While not perfect, it’s highly encouraging to see how well this entire study population performed,” Dr. Traina concluded.

‘A Lifesaving Principle’

Larry Norton, MD

Larry Norton, MD

Larry Norton, MD, Deputy Physician-in-Chief for Breast Cancer Programs, Medical Director of the Evelyn H. Lauder Breast Center, and the Norna S. Sarofim Chair in Clinical Oncology, shared his thoughts on this study in an interview with The ASCO Post.

“This critically important paper conveys several messages. One is the importance of joint analyses and overviews, such as the venerable Oxford collaboration. This latter program has long confirmed the activity of both anthracyclines and taxanes in the breast cancer adjuvant setting, so the result of this current analysis is not a surprise,” Dr. Norton remarked. “A more subtle message is that we need to re-emphasize that useful clinical trials must address principles rather than regimens.”

Given that both anthracyclines and taxanes are active, Dr. Norton said the key question is “Does one need both?” not “How does one compare to the other?” He concluded: “The fact that they are useful together (along with cyclophosphamide) is a lifesaving principle.” ■

Disclosure: Drs. Traina and Norton reported no potential conflicts of interest.


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