Cyclophosphamide-free Adjuvant Chemotherapy for Ovarian Protection in Young Women with Breast Cancer: a Randomized Phase 3 Trial
Mené sur 521 patientes atteintes d'un cancer du sein ER+ HER2- (âge médian : 34 ans), cet essai de phase III évalue l'efficacité, du point de vue du taux de reprise du cycle mentruel à 12 mois et de la survie sans maladie à 5 ans, d'une chimiothérapie adjuvante sans cyclophosphamide après une chirurgie définitive (durée médiane de suivi : 62 mois)
Résumé en anglais
Background : Chemotherapy-induced premature menopause leads to some consequences, including infertility. We initiated this randomized phase 3 trial to determine whether a cyclophosphamide-free adjuvant chemotherapy regimen would increase the likelihood of menses resumption and improve survival outcomes.
Methods : Young women with operable ER-positive HER2-negative breast cancer after definitive surgery were randomized to receive adjuvant epirubicin/cyclophosphamide followed by weekly paclitaxel (EC-wP) or epirubicin/paclitaxel followed by weekly paclitaxel (EP-wP). All patients received at least 5-year adjuvant endocrine therapy after chemotherapy. Two coprimary endpoints were the rate of menstrual resumption at 12 months after chemotherapy and 5-year disease-free survival (DFS) in the intention-to-treat population. This study is registered at ClinicalTrials.gov (NCT01026116). All statistical tests were 2-sided.
Results : Between Jan 2011 and Dec 2016, 521 patients (median age = 34 years; interquartile range = 31-38 years) were enrolled, with 261 in the EC-wP group and 260 in the EP-wP group. The rate of menstrual resumption at 12 months after chemotherapy was 48.3% in EC-wP (95% confidence interval [CI] = 42.2% to 54.3%) and 63.1% in EP-wP (95% CI = 57.2% to 68.9%), with an absolute difference of 14.8% (95% CI = 6.37% to 23.2%, P < 0.001). The post-hoc exploratory analysis by patient-reported outcome questionnaires indicated that pregnancy might occur in fewer women in the EC-wP group than in the EP-wP group. At a median follow-up of 62 months, the 5-year DFS was 78.3% (95% CI = 72.2% to 83.3%) in EC-wP and 84.7% (95% CI = 79.3% to 88.8%) in EP-wP (stratified log-rank P = 0.07). The safety data were consistent with the known safety profiles of relevant drugs.
Conclusions : The cyclophosphamide-free chemotherapy regimen might be associated with a higher probability of menses resumption.
