Dose-Dense Weekly Docetaxel in Metastatic Breast Cancer

August 2, 2000
Oncology, ONCOLOGY Vol 14 No 8, Volume 14, Issue 8

Weekly administration of taxanes as palliative treatment in metastatic breast cancer has been reported with significantly reduced hematologic toxicity and comparable efficacy to standard every-3-week protocols. This study update provides mature results with weekly docetaxel (Taxotere) in a larger patient population.

Weekly administration of taxanes as palliative treatment in metastatic breast cancer has been reported with significantly reduced hematologic toxicity and comparable efficacy to standard every-3-week protocols. This study update provides mature results with weekly docetaxel (Taxotere) in a larger patient population.

Eligibility criteria for this study included measurable disease, prior chemotherapy for metastatic disease, and ECOG (Eastern Cooperative Oncology Group) performance status £ 2.

The protocol design consisted of docetaxel, 40 mg/m²/30 min infusion weekly ´ 6, followed by a 2-week rest. Patients were premedicated with dexamethasone, 8 mg intravenously before docetaxel administration, followed by oral dexamethasone, 4 mg on the next day.

The patient characteristics were as follows: 41 evaluable patients; ECOG performance status 0/1/2: 21/18/2 patients; median age: 55.2 years (range: 47–71 years); all had one to three previous chemotherapy protocols; prior epirubicin (Ellence): 25 (61%); prior paclitaxel (Taxol): 6 (15%); delivered median dose intensity of docetaxel: 36 mg/m²/week.

Toxicity included leukopenia (grade 2/3/4): 27%/10%/2% (maximum tolerated dose, 45 mg/m²/week); no febrile neutropenia; nail toxicity (1/2): 34%; edema (1): 8%; no grade 2–4 cumulative sensory neuropathy; alopecia (2/3): 76%; asthenia (1/2): 17%; conjunctivitis (2): 2%; delay of treatment by 1 week: 7%; dose reduction to 35 mg/m²/week: 10%.

Response rates were as follows: complete response: 12%; partial response: 36%; no change: 40%; progressive disease: 12%; 3 of 6 patients with prior weekly paclitaxel responded to weekly docetaxel. Median duration of remission was 8.8 months (range: 2–12 months); median survival time was 12.8 months.

CONCLUSION: Weekly docetaxel has definite activity in chemotherapy-pretreated breast cancer that is comparable to 100 mg/m² every 3 weeks, but with substantially reduced grade 3/4 leukocyte toxicity. The low incidence of leukopenia facilitates combination therapy without compromise of docetaxel dosing. The recommended weekly dose is 40 mg/m², as further dose escalation results in grade 3/4 cumulative leukopenia, indicating a narrow toxicity margin and a maximum tolerated dose between 40 and 45 mg/m².

Click here for Dr. Gabriel N. Hortobagyi’s commentary on this abstract.