Cómo citar este artículo: Ramírez-Torres N, et al. Impacto pronóstico de la respuesta patológica completa y del estado ganglionar en pacientes con cáncer de mama avanzado tratadas con dosis alta de epirrubicina neoadyuvante. Gaceta Mexicana de Oncología. 2016. http://dx.

Evaluar la tasa de respuesta patológica completa (RPc) posterior a la quimioterapia neoadyuvante (QN) con antraciclinas con o sin taxanos en el manejo del cáncer de mama localmente avanzado (CMLA). Método: Se incluyeron pacientes con CMLA. Una cohorte recibió cuatro ciclos de FEC (5-fluorouracilo 500 mg/m 2 , epirubicina 75 mg/m 2 , ciclofosfamida 500 mg/m 2 ) cada 3 semanas seguido por cuatro ciclos de docetaxel (D) 75 mg/m 2 en infusión intravenosa de 1 hora cada 3 semanas. Otra cohorte recibió seis ciclos de FE 100 C (500, 100 y 600 mg/m 2 ). Se realizó cirugía posterior a la quimioterapia. resultados: No hubo diferencia estadísticamente significativa en las tasas de respuesta objetiva (78.5 vs. 85.0%; p = 0.299) ni en la respuesta clínica completa (20.6 vs. 33.3%; p = 0.103) para 4FEC→4D comparado con 6FE 100 C, respectivamente. En cambio, hubo una mejora significativa en la tasa de RPc (30.2 vs. 16.7%; p = 0.049) y en los ganglios linfáticos axilares negativos (51.6 vs. 35%; p = 0.03) para 4FEC→4D en comparación con 6FE 100 C, respectivamente. La toxicidad grave fue baja y no significativa en ambas cohortes. Los modelos multivariados de regresión logística mostraron que los principales predictores significativos para obtener una RPc fueron la QN con 4FEC→4D (odds ratio [OR]: 2.7; p = 0.019) y el estadio IIIA (OR: 3.8; p = 0.002). Conclusión: Este estudio mostró que el régimen 4FEC→4D con dosis convencional es muy activo y bien tolerado en pacientes con CMLA en nuestro hospital.

Objective: To detect the difference in the effectiveness of 6 FE100C as neoadjuvant chemotherapy (NCT) vs 4 FE100C and set the duration. Method. Forty-eight consecutive cases per group from January 2003 to December 2007 were registered. Patients received cyclophosphamide 500 mg/m2, epirubicin 100 mg/m2 and 5-fluorouracil 500 mg/m2 (FE100C) with 4 or 6 cycles every 21 days. They were followed by surgery and radiotherapy. Results In the analysis, the number of the largest cycle was a predictor in clinical response. Theobjective complete clinical and partial response (cCR+cPR) was 62.5% and 87.5% with 4 FE100C and 6 FE100C respectively (p <0.003); the clinical benefit was better with six FE100C with a complete response rate (cCR) of 35.4% (CI 95%: 22% −48%, n=17). The distribution of best complete pathologic response (CPR) for 6 FE100C was significantly better than for 4 FE100C (20.8% vs.12.5%, p = 0.044). The most clinically important difference in gastrointestinal toxicity caused by 6 FE100C was the effect of mild to moderate vomiting (52.4% vs. 39% for 4 FE100C, p = 0.001); the severe leukopenia (2.43% vs. 1.56%, p= 0.401) and moderate anemia (2.08% vs. 0.52%, p = 0.142) for 6 FE100C and 4 FE100C respectively. There was no significant difference between regimens. The toxicity of the nausea, alopecia and hematologic toxicity in the effect of peripheral leukocyte count and platelet presented no significant difference between regimens. The moderate anemia was rescued with blood transfusion and severe leukopenia with filgastrim. There was no cardio toxicity, thrombocytopenia or other serious events. Conclusion: Both regimens were similar for the incidence of gastric toxicity and hematologic toxicity. The scheme of six FE100C was well tolerated in patients with LABC. It was confirmed a significant improvement in the pCR and cCR with intensified epirubicin dose (100mg/m2) for 6 cycles without granulocyte colony-stimulating factor. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-11-21.