Comparative Outcomes of Doxorubicin and Cyclophosphamide with Sequential versus Concurrent Paclitaxel in the Adjuvant Treatment of Non-Metastatic Breast Cancer: A Cross-Sectional Analytical Study.

Introduction: Studies have compared the efficacy and toxicities of doxorubicin and cyclophosphamide every three weeks for four cycles followed by four cycles of paclitaxel every three weeks (AC/T); with paclitaxel, doxorubicin, and cyclophosphamide (TAC) every three weeks for six cycles for adjuvant treatment of breast cancer in western countries. Genetic and environmental disparities in Nepalese population warrant the need for similar studies in Nepal. This study compares the toxicity patterns and compliance of AC/T versus TAC in the adjuvant treatment of non-metastatic breast cancer in Nepalese women. Methods: A hospital-based cross-sectional analytic study was conducted at Bir Hospital, Kathmandu after obtaining the ethical approval (Reference number: 931/076/077). Sixty women who completed either AC/T or TAC regimens were evaluated. Confounding was minimized by strict inclusion/ exclusion criteria (restriction), group matching, and random sampling. Primary outcome was grade 3-4 hematological toxicity; secondary outcomes included other adverse effects and compliance. Results: Although hematological toxicities were higher in the TAC group, differences were not statistically significant. Non-hematological toxicities (fatigue, nausea, vomiting, pain, nail changes) were significantly higher in the TAC group. Edema was more prevalent in the AC/T group (p=0.04). Compliance without modification favored AC/T (64.5% vs. 34.5%; p=0.038). Conclusions: Sequential AC/T demonstrated superior tolerability and compliance. Confounder control through study design and statistical methods strengthens the validity of these findings, though larger studies are warranted.