Doxorubicin, Cyclophosphamide Followed by Paclitaxel Vs 5-Fluorouracil, Doxorubicin, Cyclophosphamide in Locally Advanced Breast Cancer

Abstract

Background: Breast cancer is the most common female malignancy in Bangladesh and the second most common cancer overall. Many patients with locally advanced disease (LABC) require multimodality therapy, including chemotherapy, surgery, and radiotherapy. Neoadjuvant chemotherapy serves as the essential initial treatment strategy for these patients.

Objective: To compare the treatment response and acute toxicities of Doxorubicin, Cyclophosphamide, followed by Paclitaxel (AC®P), with 5-Fluorouracil, Doxorubicin, and Cyclophosphamide (FAC) in the treatment of LABC.

Methods: This quasi-experimental study was conducted at two cancer centers in Dhaka from January 2017 to June 2018. Using convenience sampling, 120 biopsy-proven LABC patients were enrolled and alternately allocated to two groups: Group A received 3 neoadjuvant FAC cycles; Group B received 4 neoadjuvant AC cycles. Both underwent surgery and then received 3 adjuvant FAC cycles (Group A) or 4 adjuvant paclitaxel cycles (Group B). Clinical response was assessed preoperatively; pathological response from surgical specimens. Follow-up occurred at 2, 4, and 6 months post-treatment.

Result: Mean age was 43.9±10.2 years; groups were comparable in ECOG performance status, tumor stage, and nodal involvement (p>0.05). Clinical complete response favored AC’!P (16.7% vs 5.0%; p=0.068); pathological complete response occurred only in AC®P (10.0%; p=0.027). Anemia (88.3% vs 70.0%; p=0.023) and taxane-related toxicities predominated in AC’!P. Mucositis (58.3% vs 6.6%; p<0.05) and hyperpigmentation characterized FAC. Six-month recurrence was similar (6.7% vs 5.0%; p=1).

Conclusion: AC®P achieved significantly higher pathological complete response than FAC, particularly in triple-negative disease, despite increased hematologic and taxane-related toxicities. Both regimens demonstrated comparable short-term disease control. AC’!P appears more effective for neoadjuvant treatment of LABC.

J Dhaka Med Coll. 2025; 34(2) : 127-135