Dose-dense paclitaxel-containing adjuvant therapy for breast cancer

The use of dose-dense therapy is one approach to overcoming the "resistance" of malignant cells to adjuvant therapy caused by inadequate drug exposure. In this approach, active drugs are delivered sequentially at their "ideal" dose level separated by short intertreatment intervals. Thus, dose intensification is achieved by means of rapidly recycled treatments rather than by dramatic dose escalation. To overcome absolute cellular resistance, the addition of new, active, non-cross-resistant drugs holds great promise and has specifically motivated the testing of the taxanes. This article describes the results of clinical trials of dose-dense therapy, with particular emphasis on attempts to incorporate one taxane, paclitaxel (Taxol), into the dose-dense regimen of sequential doxorubicin and cyclophosphamide--the so called A-->T-->C regimen, and into more conventional regimens.