Combined doxorubicin and paclitaxel in advanced breast cancer: Effective and cardiotoxic

BACKGROUND:: Pacitaxel has shown activity in metastatic breast cancer, includinganthracycline-resistant breast cancer. The efficacy, toxicityand optimal scheduling of the combina tion of the two drugsneeds to be defined. PATIENTS AND METHODS:: Thirty women with advanced breast cancer who had undergone atmost one prior adjuvant chemotherapy regimen, were treated atthree different dose levels with doxorubicin (50, 60 and 60mg/m²) followed 30 minutes later by paclitaxel (155, 175 and200 mg/m², respectively) every 3 weeks. RESULTS:: The overall response rate was 83% (95% CI: 64–94), with24% of patients achieving CR. The median response duration forcomplete responders was 11 months (range 4–14+) and mediansurvival 18 months (range 3–28+). Two hundred sixty-fivetreatment courses were given (median 9, range 3–13) andthe median cumulative dose of doxorubicin was 369 mg/m² (range114–550). The main toxicities were neutropenia, parestesia,nausea/vomiting, alopecia, myalgia and cardiotoxicity. Fifteenpatients (50%) had reductions of left ventricular ejection fractionto below normal levels and 6 of these patients (20%) developedcongestive heart failure. CONCLUSIONS:: The combination of doxorubicin and paclitaxel is highly active,but is accompanied by the dose-limiting toxic effects of neutropenia,neuropathy and cardiotoxicity. advanced breast cancer, cardiotoxicity, doxorubicin, paclitaxel