| showed that improvements in eff icacy
noted at 5 years with the addition
of docetaxel to anthracycline-based
treatment were maintained at 10 years
for both progression-free survivial and
overall survival in women with nodepositive
breast cancer.2 Congestive
heart failure—one of two important
late-term toxic eff ects of anthracyclines
in the adjuvant treatment of breast
cancer—was reported for 26 (3%)
of 744 patients given docetaxel,
doxorubicin, and cyclophosphamide
(TAC), and for 17 (2%) of
736 given fl uorouracil, doxorubicin,
and cyclophosphamide (FAC; p=0·175).
The second toxic eff ect, secondary
haematological malignancies, will
be a growing problem in the near
future with regards to increased
survival. These malignancies arise
in 0·3–1·7% of patients with breast
cancer who are receiving antineoplastic
chemotherapy.3–5
In the 10 year analysis, the BCIRG 001
study investigators reported secondary
hematological malignancies in six
patients in the TAC group and three
patients in the FAC group (p=0·51).
The absence of a significant diff erence
between the two groups might be
related to the low frequency of these
events. The heightened risk in patients
given TAC might be attributable to the
increased use of granulocyte colonystimulating
factor (G-CSF) in this
group; however, no directly reported
data are available. Use of G-CSF was
mandatory after the first episode of
febrile neutropenia in the study, and
febrile neutropenia was more frequent
in TAC patients than in those given FAC |