Efficacy of AC-T Versus TAC Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer: A Retrospective Analysis.

PURPOSE: Locally advanced breast cancer (LABC) remains a major therapeutic challenge, with neoadjuvant chemotherapy (NAC) serving as a cornerstone of management. However, direct evidence comparing the efficacy of sequential (AC-T) and concurrent (TAC) anthracycline-taxane regimens in real-world Middle Eastern populations remains scarce. This study is aimed at comparing the clinical outcomes of AC-T and TAC in Iranian women with LABC.

METHODS

A retrospective cohort study was conducted among 118 patients with Stage III breast cancer treated at Tehran, Iran. Patients received either AC-T (doxorubicin/cyclophosphamide followed by paclitaxel; n = 70) or TAC (docetaxel/doxorubicin/cyclophosphamide; n = 48). Outcomes included pathological complete response (pCR), overall survival (OS), disease-free survival (DFS), distant recurrence-free survival (DRFS), and locoregional recurrence-free survival (LRFS).

RESULTS

Baseline demographic and clinical characteristics were comparable between groups. No significant difference in pCR rates was observed between the groups. The AC-T regimen showed higher, though nonsignificant, OS at 3, 5, and 10 years (90%, 82%, and 71%, respectively) compared with TAC (83%, 74%, and 57%). Conversely, TAC demonstrated significantly superior 10-year DRFS (62% vs. 45%, p = 0.019). DFS and LRFS were similar between regimens. Multivariable Cox regression analysis identified ER positivity as the only independent predictor of improved OS (HR = 0.42, 95% CI: 0.29-0.82, p = 0.012) and DFS (HR = 0.36, 95% CI: 0.18-0.73, p = 0.005), whereas the chemotherapy regimen was not independently associated with survival after adjustment for confounders.

CONCLUSION

Both AC-T and TAC provided effective neoadjuvant control in LABC, with comparable survival outcomes. These findings support individualized regimen selection based on patient profile and tumor biology. Prospective studies are needed to refine region-specific treatment strategies.