Docetaxel alternating with epirubicin and cyclophosphamide: a feasibility study in breast cancer patients

Docetaxel is one of the most active drugs used in the treatment of breast cancer. However, its major side-effect, myelosuppression, hampers full-dose combination chemotherapy. We have, therefore, developed an alternating schedule of docetaxel with epirubicin and cyclophosphamide, together with granulocyte colony-stimulating factor, to ameliorate neutropenia. We studied the feasibility of such a strategy, decreasing the treatment interval from 21 days to 14 days, thus further increasing the dose intensity. As expected, myelosuppression was common, complicated by neutropenic fever, which did not exceed preset criteria. Other side-effects were also as expected: alopecia, malaise, nausea and vomiting. After two alternating courses of chemotherapy, a partial response was documented in 15 of 17 patients. We conclude that this alternating schedule is very active against breast cancer and warrants further phase II studies.