Early breast cancer: docetaxel-capecitabine no better than standard anthracycline chemo in MINDACT

  • Delaloge S & al.
  • J Clin Oncol
  • 21 Feb 2020

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Results of a randomized controlled trial show that the combination of capecitabine plus docetaxel (DC) is neither safer nor more effective than standard anthracycline-based chemotherapy in early breast cancer.
  • Most participants were at high clinical and genomic risk according to MammaPrint.

Why this matters

  • Results counter expectations that DC would be safer and superior in efficacy.

Study design

  • MINDACT Phase 3 trial involving patients with early breast cancer who underwent a second random allocation to either DC (n=652, 60.4% at high clinical/genomic risk) or standard anthracycline-based chemotherapy (n=649, 60.6% at high clinical/genomic risk).
  • Primary outcome: DFS.
  • Funding: Industry funders; Breast Cancer Research Foundation; NIH; others.

Key results

  • No difference between groups in DFS at median 5 years of follow-up:
    • 90.7% in DC group vs 88.8% in anthracycline-based group;
    • HR, 0.83 (P=.26).
  • No difference in DFS between subgroups with high clinical/high genomic risk:
    • 88.1% DC vs 86.1% standard therapy;
    • HR, 0.83 (95% CI, 0.58-1.21).
  • DC group had higher rates of grade 1 neuropathy (27.1% vs 11.2%) and grade 2 hand/foot syndrome (28.5% vs 3.3%) but fewer second cancers (21 vs 32).

Limitations

  • Study was underpowered, so results are only suggestive and need further evaluation.