Dose-Dense Chemotherapy

Author: OncoLink Team
Content Contributor: Allyson Distel, MPH
Last Reviewed: April 10, 2024

What is chemotherapy?

Chemotherapy is a type of medicine that is used to treat cancer. Cancer cells grow and reproduce (multiply) very quickly. Normal, healthy cells know to stop growing and reproducing when they touch other cells. Cancer cells keep growing, not knowing when to stop. RNA and DNA in the cell tell it how to grow and reproduce. Chemotherapy hurts the RNA or DNA, stopping the cancer from growing. A chemotherapy regimen is a group of medications given to treat certain types of cancer.

What is dose-dense chemotherapy?

Dose-Dense Chemotherapy (DDC) is a way to give chemotherapy regimens more often than normal. The goal of DDC is to kill as much of the tumor as it can. The actual dose of chemotherapy is not increased, but the time between doses is lessened. By giving the same doses of chemotherapy more often, the chemotherapy stops the rapid (quick) growth phase of the tumor cells. The medications hit the tumor cells at the time when they are just starting to grow again. This model was called the Norton-Simon model, after the researchers who first described it.

A concern of DDC is that giving chemotherapy more often would lead to low white blood counts and infection. Through the use of growth factors like Filgrastim (Neupogen®, G-CSF), Pegfilgrastim (Neulasta®), and Sargramostim (Leukine®, GM-CSF), your white blood cells can heal faster, lessening the chance of infection. DDC studies have shown a higher rate of anemia (low red blood cell count) and bone pain (likely linked to the use of a growth factor) with these regimens, but the DDC regimens also shorten the length of therapy by 4-6 weeks.

What types of cancer is DDC used in?

Studies have found that premenopausal women with high-risk breast cancer (hormone receptor-negative, Her2 positive, and lymph node-positive) see the most benefit from DDC. This study also found that the use of DDC does not seem to be linked with an added risk of treatment-induced/early menopause or amenorrhea (absence of menstrual periods). This is an important finding because early menopause can cause your ovaries to stop working, which can increase the risk of:

  • Osteoporosis.
  • Early heart disease.
  • Infertility.
  • Hot flashes.
  • Vaginal dryness.
  • Weight gain.

These side effects can be hard to cope with and have a harmful impact on women of childbearing age.

DDC is used to treat some high-risk lymphomas. Studies are still looking at DDC used with Rituximab (Rituxan®). Studies have also looked at using DDC in ovarian cancer.

There is a benefit to DDC for some patients. Deciding who will benefit is the focus of ongoing studies in these and other types of cancer. Longer follow-up of studies that were done before will help us learn more about DDC and its use.

If your treatment plan includes dose-dense chemotherapy, talk with your care team about any concerns you may have.

Brusamolino E, Rusconi C, Montalbetti L, Gargantini L, Uziel L, Pinotti G, Fava S, Rigacci L, Pagnucco G, Pascutto C, Morra E, Lazzarino M. Dose-dense R-CHOP-14 supported by pegfilgrastim in patients with diffuse large B-cell lymphoma: a phase II study of feasibility and toxicity. Haematologica. 2006 Apr; 91(4):496-502.

Blayney DW, LeBlanc ML, Grogan T, Gaynor ER, Chapman RA, Spiridonidis CH, Taylor SA, Bearman SI, Miller TP, Fisher RI; Southwest Oncology Group. Dose-intense chemotherapy every 2 weeks with dose-intense cyclophosphamide, doxorubicin, vincristine, and prednisone may improve survival in intermediate- and high-grade lymphoma: a phase II study of the Southwest Oncology Group (SWOG 9349). J Clin Oncol. 2003 Jul 1; 21(13):2466-73.

Cunningham et al. A phase III trial comparing R-CHOP 14 and R-CHOP 21 for the treatment of patients with newly diagnosed diffuse large B-cell non-Hodgkin's lymphoma. J Clin Oncol 27:15s, 2009 (suppl; abstr 8506).

Current Opinion in Obstetrics & Gynecology. 19(1):75-81, February 2007.

Green MC et al. Weekly paclitaxel improves pathologic complete remission in operable breast cancer when compared with paclitaxel once every 3 weeks. J Clin Oncol 2005:23:5983-5992.

Gregory SA. Trumper L. Chemotherapy dose intensity in non-Hodgkin's lymphoma: is dose intensity an emerging paradigm for better outcomes? Annals of Oncology 2005:16(9):1413-24.

Katsumata N. et al. Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial. Lancet. 2009 Oct 17;374(9698):1331-8. Epub 2009 Sep 18.

Kummel S et al. Dose-dense chemotherapy for primary breast cancer.

Kummel S. et al. Randomised trial: survival benefit and safety of adjuvant dose-dense chemotherapy for node-positive breast cancer. British Journal of Cancer 2006:94(9):1237-44.

Lin NU, Gelman R, Winer EP. Dose Density in Breast Cancer: A Simple Message? J Natl Cancer Inst 2005;97:1712-1714.

Norton L. Conceptual and practical implications of breast tissue geometry: toward a more effective, less toxic therapy. Oncologist. 2005;10:370-381.

Pfreundschuh M, Trumper L, Kloess M, Schmits R, Feller AC, Rudolph C, Reiser M, Hossfeld DK, Metzner B, Hasenclever D, Schmitz N, Glass B, Rube C, Loeffler M. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of young patients with good-prognosis (normal LDH) aggressive lymphomas: results of the NHL -B1 trial of the DSHNHL. Blood. 2004 Aug 1; 104(3):626-33.

Seidman AD. Current status of dose - dense chemotherapy for breast cancer. Cancer Chemotherapy & Pharmacology 2005: 56 Suppl 1:78-83.

Untch M. et al. Dose-dense sequential epirubicin-paclitaxel as preoperative treatment of breast cancer: results of a randomized trial AGO study (abstract 133). Proc Am Soc Clin Oncol 2005: 21:34A.

Venturini M et al. Dose-Dense Adjuvant Chemotherapy in Early Breast Cancer Patients: Results from a Randomized Trial. J Natl Cancer Inst 2005;97:1724-173

Related Blog Posts

May 31, 2023

A Poet’s Autobiography of Cancer

by OncoLink Team

April 19, 2023

Happy Occupational Therapy Month

by OncoLink Team

September 16, 2022

Wine Racks and the Mystery of Survival

by Rodney Warner, JD