Investigators from the National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, Pennsylvania, evaluated pathologic CR in a clinical trial (Protocol B27) that compared 4 cycles of conventional doxorubicin and cyclophosphamide (AC) chemotherapy given preoperatively to 4 cycles of AC followed by 4 cycles of docetaxel (100 mg/m2 every 3 weeks x 4 cycles). [2] The 3 treatment arms included AC alone, AC followed by surgery followed by postoperative docetaxel, and AC followed by docetaxel before surgery. Ann's NOTE: The response rate with Taxol reached 65% versus 40% with one. However as you can see below, there were many complications and people died. Additionally, as always, there is a question as to whether this response rate will actually translate into improved survival! AC was associated with 2 treatment-related deaths and about a 10% rate of grade 4 complications. Docetaxel was associated with 6 deaths and a 24% incidence of grade 4 complications, mainly neutropenia. Although bowel perforations attributed to docetaxel occurred early in the study when high doses of corticosteroids were used, this problem was resolved by changing to the currently recommended steroid premedication regimen (dexamethasone 8 mg bid x 3 days beginning 1 day before docetaxel treatment). Further follow-up will be required in order to determine whether the improvement in clinical and pathologic CR rate translates into improved survival. MEDSCAPE Report had summaries of several chemotherapeutic studies. Here are the some of the conclusions: Summary and Clinical Implications The addition of preoperative docetaxel (4 cycles) to conventional neoadjuvant AC therapy significantly improves the pathologic complete response rate in stage I-IIIA disease, and improves pathologic CR rate and survival in patients with locally advanced disease. Further investigation of this treatment regimen is warranted. Anthracycline-taxane combinations for metastatic disease are more active but are also more toxic and generally do not improve survival compared with use of these drugs sequentially as long as there is crossover to taxane therapy at progression. Administration of up to 6 cycles of doxorubicin and paclitaxel safe and feasible in the neoadjuvant setting. Preliminary evidence suggests that the combination of trastuzumab with liposomal anthracyclines is safe and does not produce prohibitive cardiac toxicity. Ann's NOTE: Sadly our idea of acceptable toxicity differs greatly from the researchers who report these phenomeon. Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.