Neoadjuvant Dose-Dense and Dose-Intensified Chemotherapy in Breast Cancer - Review of the Literature

Abstract

Dose-dense chemotherapy in the adjuvant and neoadjuvant setting has been intensively examined over the past few decades, and even seems to have become a standard regimen in certain subgroups of patients with increased risk of relapse. Nevertheless, there are conflicting data regarding the absolute benefit of this regimen, especially in the neoadjuvant setting. Pathological complete response (pCR) is used as a surrogate marker for disease-free and overall survival. Meta-analyses have recently questioned the use of pCR as a generalized prognostic tool for all subgroups, but also determined a correlation between treatment effects on the surrogate outcome and the treatment effect on the clinical outcome in the cohort of patients receiving dose-dense chemotherapy. The present paper gives an overview of the definitions of dose-dense and dose-intensified chemotherapy regimens and of the literature for neoadjuvant dose-dense, dose-intensified studies, and summarizes the outcome of these studies.

Keywords: Breast cancer; Dose-dense chemotherapy; Neoadjuvant therapy.

Fig. 1

Standard chemotherapy (A) versus dose-dense chemotherapy (B) and dose-intensified chemotherapy (C). Chemotherapy with epirubicin/cyclophosphamide (EC) is used as an example to clarify the dosing as well as the timing.