Dose-Dense Sequential Adriamycin-Paclitaxel-Cyclophosphamide Chemotherapy Is Well Tolerated and Safe in High-Risk Early Breast Cancer

<i>Objective:</i> The feasibility of dose-dense sequential adjuvant chemotherapy with Adriamycin, paclitaxel and cyclophosphamide was evaluated. <i>Methods:</i> Fifty-five high-risk breast cancer patients were enrolled. The following chemotherapy schedule was used: 4 × Adriamycin → 4 × paclitaxel → 4 × cyclophosphamide, q 2 weeks (Adriamycin, 60 mg/m²; paclitaxel, 200 mg/m² over 3 h, and cyclophosphamide, 800 mg/m²). <i>Results:</i> The dose intensity was 95.0, 99.8 and 97.4% of that planned for treatment with Adriamycin, paclitaxel and cyclophosphamide, respectively. During treatment with Adriamycin, paclitaxel and cyclophosphamide, 20, 12.7 and 25.5% of the patients, respectively, did not need filgrastim to maintain the dose density. The average number of filgrastim doses per cycle, when necessary, was 3.6. Neutropenia of grade 3–4 was found in 67.3, 13.5 and 10.0% of the patients after treatment with Adriamycin, paclitaxel and cyclophosphamide, respectively. A single case of febrile neutropenia was observed. Anemia occurred in 96.4% of the patients, and was significantly more frequent (p = 0.031) and more severe (p = 0.002) during paclitaxel treatment than in the other chemotherapy cycles. <i>Conclusions:</i> Dose-dense sequential chemotherapy with Adriamycin, paclitaxel and cyclophosphamide is well tolerated and safe. Individual treatment with granulocyte colony-stimulating factor is needed to maintain the dose density in most patients, but some tolerate this regimen without it, probably due to differences in drug clearances.