Adjuvant concurrent docetaxel, epirubicin and cyclophosphamide chemotherapy in breast cancer: The TEC regimen. A retrospective analysis

Background: The use of taxanes and anthracyclines in the adjuvant treatment of primary breast cancer is well established, with benefit in both disease free survival (DFS) and overall survival (OS). Several studies demonstrated that the addition of taxanes to anthracycline-based chemotherapy improves the outcome in either concurrent or sequential schedule. Nowadays, the TAC regimen (docetaxel, doxorubicin and cyclophosphamide) is a standard treatment in both node-positive and high-risk node-negative early breast cancer. Doxorubicin and epirubicin are equivalent, but at similar doses epirubicin appears to have a better side effects profile than doxorubicin in terms of myelosuppression and cardiotoxicity. We conducted a retrospective study to establish the role of TEC (epirubicin) regimen in adjuvant setting. Methods: Preor post-menopausal women, with stage I-III breast cancer, PS ECOG 0-2 and normal left ventricular ejection fraction, were eligible. TEC chemotherapy at median doses of docetaxel 75 mg/m2, epirubicin 60 mg/m2 and cyclophosphamide 500 mg/m2 was administered IV on day 1 every three weeks for 6 cycles. The primary endpoint was toxicity; secondary endpoints were DFS and OS. Results: Thirty-three consecutive female patients were retrospectively enrolled. The median age was 57 years old. Eighty eight percentage of patients completed the treatment plan. In 21.2% of cases a dose reduction was performed and these patients needed a chemotherapy interval prolongation. The main side effects were neutropenia G3-4 (21.2%; 95% CI, 9.8-37.5), allergic reaction G3 to docetaxel (6.1%; 95% CI, 1.0-18.6) and febrile neutropenia (3.0%; 95% CI, 0.1-14.0), while cardiotoxicity was absent (95% CI, 0-8.7%). Globally, the percentage of any other severe side effect was very low and no one toxic death was seen. The 3-year DFS and OS were 89.9% (95% CI, 79.0-100) and 93.8% (95% CI, 85.6-100), respectively. Conclusions: As compared to TAC treatment, TEC regimen with epirubicin 60 mg/m2 is feasible and well tolerated adjuvant chemotherapy in breast cancer, with acceptable and manageable toxicity.