No abstract

Metastatic breast cancer is mostly incurable. Progressively overall survival (OS) has improved but few authors have studied treatment globally versus for each line and demonstrated the interest of chemotherapy (CT) after the third line. We selected recent patients treated during the "taxane/anti-aromatase era" for each line given. 529 received CT and 383 hormonotherapy. OS was assessed; from the date of first metastasis and from Day 1 of each CT line. Median OS was 34.1 months; 226 patients received >3 lines of CT with a steady median OS for late lines, 11.4 months per line (range 10.4-12.6). Clinical benefit after the third line of CT was obtained for 29.2-36.6% of patients. CT lasted 11.7 months "on"versus 20.6 months "off" CT. These results may support the use of more than 3 CT lines; each line can contribute to a longer survival.

Background. Neoadjuvant treatment provides a unique opportunity to evaluate individual tumor sensitivity. This study evaluated whether a response-guided strategy could improve clinical outcome compared with a standard treatment. Methods. Overall, 264 previously untreated stage II-III operable breast cancer patients were randomized to receive either standard treatment (arm A, n 5 131), consisting of fluorouracil, epirubicin, and cyclophosphamide (FEC100: 500, 100, and 500 mg/m 2 , respectively, for 3 cycles) followed by docetaxel (100 mg/m 2 for 3 cycles), or adapted treatment (arm B, n 5 133), beginning with 2 cycles of FEC100 and switching to docetaxel if tumor size decreased by ,30% after 2 cycles or ,50% after 4 cycles of FEC100 (ultrasound assessments according to World Health Organization criteria). Otherwise, FEC100 was given for six cycles before surgery. Intent-to-treat analysis was performed. Results. Similar results were observed for clinical response (objective response was 54% vs 56%, p 5 .18), breast conservation surgery (BCS; 67% vs 68%, p 5 .97), and pathological complete response rate (Chevallier classification: 14% vs 11%, p 5 .68; Statloff classification: 16% vs 13%, p 5 .82) between arms A and B. Similar toxicities were observed, even with unbalanced numbers of FEC100 and docetaxel courses.