Dose-dense (DD) AC followed by paclitaxel is associated with moderate, frequent anemia compared to sequential (S) and/or less DD Treatment: Update by CALGB on Breast Cancer Intergroup Trial C9741 with ECOG, SWOG, & NCCTG

620 Background: C9741 demonstrated superior DFS and OS for q14 day A, T, and C compared to q21 day treatment and no difference in outcomes with concurrent vs. sequential A and C. (J Clin Oncol 21:1431–39. 2003) Study design: Arm S3: Ax4 ->Tx4->Cx4 q3 weeks; Arm S2 (DD): Ax4->Tx4->Cx4 q2 weeks with filgrastim; Arm C3: ACx4->Tx4 q3 weeks; Arm C2 (DD): ACx4->Tx4 q2 weeks with filgrastim; A=doxorubicin 60mg/m2, T=paclitaxel 175 mg/m2 over 3 hours, and C=cyclophosphamide 600mg/m2. Red cell transfusion was observed in 13% of the first 412 patients (3,973 treatment cycles) with C2, compared to less than 4% in S2 and C3, and zero in S3. This observation prompted a more detailed review of the toxicity data. Methods: We performed a retrospective review of hemoglobin per course, use of epoetin alpha and transfusions. Use of epoetin alpha and transfusions were at discretion of physician. Time-to-event distributions were estimated by the Kaplan-Meier technique; two or more such distributions were compared with the log...