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Dose-dense Chemotherapy — SCE Medical Oncology MCQ

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ModerateBreast CancerDose-dense ChemotherapySCE Medical Oncology

A 58-year-old woman on dose-dense AC (doxorubicin + cyclophosphamide given every 2 weeks with G-CSF support) for early breast cancer asks why the dose-dense schedule is used. What is the rationale?

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Correct answer: A — More frequent dosing (every 2 weeks vs 3 weeks) maintains cytotoxic drug exposure and allows less tumour regrowth between cycles, improving DFS — supported by the CALGB 9741 and GIM-2 trials

Dose-dense chemotherapy delivers standard drug doses at shorter intervals (2-weekly vs 3-weekly), supported by G-CSF. The Norton-Simon mathematical model predicts that shorter inter-cycle intervals reduce tumour regrowth. CALGB 9741 showed DFS improvement with dose-dense AC→T. The GIM-2 trial confirmed OS benefit with dose-dense EC-T. This is now standard for high-risk early breast cancer in the UK. G-CSF (pegfilgrastim) is essential to prevent neutropenia.

Reference: ESMO 2024 Early Breast Cancer; CALGB 9741 Citron et al JCO 2003; GIM-2