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. 2019 Feb 18;2019(2):CD012873. doi: 10.1002/14651858.CD012873.pub2

Abe 2013.

Methods Accrual: June 2006 to April 2008
Phase II randomised controlled trial conducted in Japan
Adjuvant therapy
Multicentre or single centre: not reported
Median follow‐up: not reported
Participants Age: median 52 years, range 29 to 64 years
55% postmenopausal
Node‐positive or high‐risk node‐negative women
Stage I/IIA/IIB: 100% (83% stage II)
Axillary lymph node involvement: 0: 57%; 1–3: 33%; ≥ 4: 10%
Hormone receptor‐positive: 55%
HER2‐positive: 24%
Excluded: prior chemotherapy or hormone therapy as neoadjuvant or adjuvant therapy
Interventions Arm 1 ('arm B' in the trial publication): docetaxel (100 mg/m²) every 3 weeks for 3 cycles followed by fluorouracil (500 mg/m²), epirubicin (100 mg/m²), cyclophosphamide (500 mg/m²) every 3 weeks for 3 cycles.
Arm 2 ('arm A' in the trial publication): fluorouracil (500 mg/m²), epirubicin (100 mg/m²), cyclophosphamide (500 mg/m²) every 3 weeks for 3 cycles followed by docetaxel (100 mg/m²) every 3 weeks for 3 cycles.
For both arms: G‐CSF if ANC < 500 μL (full blood count measured on day 8) or febrile neutropenia
Outcomes Primary outcome
  • Toxicity, assessed using the NCI CTC version 3


Secondary outcomes
  • Treatment adherence measures that included the number of participants in each arm who completed all intended treatment cycles, and RDI (total cumulative drug dose the participant actually received per unit time divided by the planned cumulative dose per unit time)

Notes Clinical trial registration record not found
Trialists contacted in July 2018 requesting information on mean RDI (mismatch of data in Table 2 and text); as of 16 August 2018, no reply received
Funding considerations: no information available
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Patients were "randomised to two arms;" no further details provided; however, baseline characteristics across the 2 arms were balanced.
Allocation concealment (selection bias) Unclear risk No details provided in trial publication.
Blinding of participants and personnel (performance bias) 
 All outcomes Low risk Likely to be an open‐label study. Participants in both groups received the same drugs though in different order. Therefore, it was unlikely that this would lead to a material bias in participants' and physicians' behaviours even when unblinded.
Blinding of outcome assessment (detection bias) 
 Toxicity and treatment adherence Unclear risk Study used formalised toxicity criteria (NCI CTC version 3) and measured a range of toxicity outcomes where some may have been affected by unblinding (e.g. neuropathy) in borderline cases. Dose‐reduction/delays were based on toxicity assessments. Overall, unblinding may have influenced physicians' assessments on a subset of outcomes assessed.
Incomplete outcome data (attrition bias) 
 All outcomes Low risk 1 discontinuation in the intervention arm (due to neutropenia).
Selective reporting (reporting bias) Low risk Clinical trial registry record not found (trial ran from June 2006 to April 2008). All outcomes reported in the Methods section had the corresponding results in the publication.
Other bias Low risk None identified