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The chemotherapy combination consisting of docetaxel, doxorubicin and cyclophosphamide (TAC) administered in sequential order has produced encouraging results for patients with metastatic breast cancer, according to a recent article published in the Journal of Clinical Oncology.

Breast cancer is a common malignancy occurring in women in the United States with approximately 200,000 new cases diagnosed each year. Breast cancer is characterized by the presence of cancer cells in the tissues or ducts of the breast. Metastatic or advanced breast cancer refers to cancer that has spread outside the breast to distant locations in the body, often including vital organs. Patients with this stage of breast cancer are typically considered to have a poor prognosis. There is no defined standard treatment for patients with this disease; however, combination chemotherapy regimens including an anthracycline (doxorubicin or epirubicin) are typically used as initial treatment. Taxanes (docetaxel and paclitaxel) are also emerging as promising additions to chemotherapy combinations. Different chemotherapy combinations are continually being evaluated in an attempt to produce the greatest survival time coupled with improved quality of life for patients with this disease.

A previous clinical trial evaluating TAC as treatment for metastatic breast cancer demonstrated encouraging results. Therefore, researchers from Italy recently conducted a clinical trial in order to further define the clinical relevance of this treatment regimen for patients with metastatic breast cancer. This trial involved 42 patients with metastatic breast cancer who received TAC as initial therapy for their disease. TAC was administered sequentially, beginning with docetaxel (T) and followed by doxorubicin (A) and cyclophosphamide (C). Subsequent treatment was then administered to 33 patients, 29 of whom received only docetaxel and 4 of whom received the combination of doxorubicin and cyclophosphamide. Anti-cancer responses following treatment were achieved in the following sequence: 62% following initial treatment with docetaxel, 69% following the addition of doxorubicin and cyclophosphamide and 71.4% following subsequent treatment with either docetaxel or the combination of doxorubicin and cyclophosphamide. The average time to cancer progression was 46 weeks and the average overall survival was 32 months. Neutropenia was the most common side effect, however severe infections rarely occurred. There were no treatment-related deaths in this trial.

These results are consistent with the previous trial evaluating TAC and represent a promising initial treatment option for patients with metastatic breast cancer. Clinical trials directly comparing various chemotherapy combinations and dosage regimens are currently ongoing. Results from these trials will help define the potential role of sequential TAC in the clinical setting as initial treatment for metastatic breast cancer.

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Patients with metastatic breast cancer may wish to speak with their physician about the risks and benefits of participating in a clinical trial evaluating TAC or other promising treatments. Two sources of information regarding ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute ( and also provides personalized clinical trial searches on behalf of patients. ( Journal of Clinical Oncology, Vol 19, No 14, pp 3367-3375, 2001)

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