Dose-Dense Primary Chemotherapy, as Part of Multidisciplinary Treatment, for Inoperable Stage III B Breast Cancer – Long-Term Results of a Phase II Trial

Abstract

Background: Primary chemotherapy as part of multidisciplinary approach is the established treatment for inoperable stage III B breast cancer. The primary endpoints were conversion to operable disease and feasibility of conservative surgery (breast-conserving therapy: BCT); secondary were clinical and pathological complete response rate, local and distant control and safety of the primary regimen. Methods: Between 1998 and 2001, 40 inoperable breast cancer patients ≤60 years, 72% T4abc and 28% T4d, received 6 cycles of primary PEV dose-dense regimen: cisplatin 50 mg/m², epirubicin 100 mg/m² and vinorelbine 25 mg/m², i.v. (q 14). Modified radical mastectomy (MRM) or BCT was performed, followed by adjuvant chemotherapy, radiotherapy and hormone therapy. Results: All patients were converted to operable disease, and BCT was feasible in 24% of T4abc patients. After a median follow-up of 84 months (range 58–96), local and distant relapses were 7.5% (0% in BCT ) and 25% (25% in BCT), respectively. Clinical response was 80% (clinical complete response [cCR]: 20%); pathological complete response (pCR) was 40% in breast, 50% in axilla (pLN0); 32% both in breast and axilla. Neutropenia (G4, 30%), leukopenia (G4, 25%), alopecia (G2, 100%), nausea and vomiting (G4, 20%) were the most common toxicities. Conclusions: The PEV dose-dense regimen seems to be highly effective in terms of resectability and pCR. Toxicity, mainly hematological, was acceptable. Successful BCT is feasible, in selected patients, without compromising local and distant control.

Prospective phase II study of neoadjuvant doxorubicin followed by cisplatin/docetaxel in locally advanced breast cancer

“…In other randomized phase III trial [34] of preoperative infusional 5-fluorouracil, epirubicin, and cisplatin (infusional ECisF) versus conventional doxorubicin and cyclophosphamide (AC) (TOPIC1), the pCR in breast including DCIS were similar (24 and 25%, respectively); at median follow-up of 5 years, the OS was 82% for ECisF and 74% for AC (P = 0.18). Recently, Massidda et al [35] reported of pCR using Sataloff's classification of 32% in both breast and axilla using dose dense of cisplatin, epirubicin, and vinorelbine (PEV) regimen every 2 weeks with G-CSF support in T4 and inflammatory breast cancer; at median follow-up of 7 years the reported DFS and OS was 75 and 80%, respectively, which is similar to our result. Among our relapsed patients, 46% was Her2 positive.…”

Inflammatory breast cancer in Italy

“…Between 1990 and 1996, the patients received older standard primary chemotherapy regimens (eg, 5‐fluorouracil, epirubicin, and cyclophosphamide; epirubicin and cyclophosphamide; or cyclophosphamide, methotrexate, and 5‐fluorouracil). From 1996 onward, patients received new standard regimens, including intensified cisplatin‐epirubicin with or without taxanes 23…”