Dose-response relationship of epirubicin-based first-line chemotherapy for advanced breast cancer: a prospective randomized trial.

Focan, C; Andrien, J. M.; Closon, Marie-Thérèse; Dicato, Mario; Driesschaert, P.; Focan-Henrard, D; Lemaire, M; Lobelle, Jean Pierre; Longrée, L.; Ries, F.

doi:10.1200/jco.1993.11.7.1253

Cited by 116 publications

(26 citation statements)

References 28 publications

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“…The rationale for high-dose therapy is a dose-response relationship and optimal scheduling-which has been demonstrated for breast cancer by several uncontrolled and controlled studies (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). These observations have been questioned by other authors (16), but the data today strongly support the fact that an increased dose intensity will be translated into an increased response rate.…”

Section: Dose Responsecontrasting

confidence: 44%

High-Dose Therapy with Autologous Bone Marrow Stem Cell Support in Primary and Metastatic Human Breast Cancer

Bergh

1995

Acta Oncologica

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Section: Dose Responsecontrasting

confidence: 44%

High-Dose Therapy with Autologous Bone Marrow Stem Cell Support in Primary and Metastatic Human Breast Cancer

Bergh

1995

Acta Oncologica

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“…All but one highlighted an advantage in terms of response rate in standard dose arms, but none of these assessed the true role of dose intensity. In fact, analysing data from three studies with more than 100 patients each, two (Tannock et al, 1988;Focan et al, 1990) did not report any data about total dose delivered, while in the third (Habeshaw et al, 1991), the significant increase in median dose intensity reported was associated with a significant increase in median total dose. A study conducted at the M.D.…”

Section: ~~~~~~~~~~~Discussion Doomentioning

confidence: 99%

“…Hryniuk and Bush (1991) first observed in a retrospective study the direct correlation between dose intensity and clinical outcome in advanced breast cancer. We are aware of at least 11 randomised trials that have prospectively explored the role of dose or dose intensity in advanced breast cancer (Tannock et al, 1988;Habeshaw et al, 1991;Carmo-Peirera et al, 1987;Hoogstraten et al, 1976;O'Bryan et al, 1977;Forastiere et al, 1982;Beretta et al, 1986;Hortobagyi et al, 1987;Ebbs et al, 1989;Becher et al, 1990;Focan et al, 1990). Seven of these, actually addressed the value of standard, or almost standard, doses of chemotherapy compared with low doses (Tannock et al, 1988;Habeshaw et al, 1991;Carmo-Peirera et al, 1987;Hoogstraten et al, 1976;O'Bryan et al, 1977;Forastiere et al, 1982;Focan et al, 1990).…”

Section: ~~~~~~~~~~~Discussion Doomentioning

confidence: 99%

Granulocyte-macrophage colony-stimulating factor (GM-CSF) allows acceleration and dose intensity increase of CEF chemotherapy: a randomised study in patients with advanced breast cancer

Ardizzoni

Venturini²,

Sertoli

et al. 1994

Br J Cancer

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Summary A randomised study was conducted in 62 patients with advanced breast cancer to assess whether granulocyte-macrophage colony-stimulating factor (GM-CSF) would yield an increase in the dose intensity of a standard-dose CEF regimen through an acceleration of chemotherapy administration. Patients received CEF (cyclophosphamide 600 mg m'2, epidoxorubicin 60 mg m-2 and fluorouracil 600 mg m-2) i.v. on day 1 or the same chemotherapy, plus GM-CSF 1Ol g kg-I s.c. starting from day 4, repeated as soon as haematopoietic recovery from nadir occurred. Patients in the CEF + GM-CSF group received chemotherapy at a median interval of 16 days compared with 20 days in the control group. This led to a significant increase (P = 0.02) in the dose intensity actually administered in the third, fourth and sixth cycles: +28%, +25%, +20% respectively. Non-haematological toxicity was mild. GM-CSF had to be reduced or suspended in 50% of patients because of toxicity. Haematological toxicity, mainly cumulative anaemia and thrombocytopenia, was manageable. An increase in response rate for patients with measurable disease, of borderline statistical significance (P= 0.088, P for trend = 0.018), from 42% in the CEF group to 69% in the CEF + GM-CSF group, was observed. This randomised trial indicates that GM-CSF is useful for chemotherapy acceleration. Accelerated CEF + GM-CSF is a moderately dose-intensive regimen that can be administered in an outpatient clinic and is associated with a high objective response.

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“…Clinical trials in metastatic breast cancer, in which dose intensity of chemotherapy was the most important variable, have shown that the response rate to chemotherapy rises with increasing dose intensity (5)(6)(7)(8). More intensive treatments might also reduce the incidence of bone and visceral relapses and have a greater influence on survival.…”

Section: Introductionmentioning

confidence: 99%

Predicting Early Failure after Adjuvant Chemotherapy in High-Risk Breast Cancer Patients with Extensive Lymph Node Involvement

Faneyte

Peterse²,

Tinteren³

et al. 2004

Clinical Cancer Research

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Purpose: There is limited knowledge of risk factors for breast cancer recurrence within 2 years. This study aimed to predict early failure and identify high-risk patients for prognostic and therapeutic purposes.Experimental Design: We studied 739 patients from a randomized trial who were <56 years of age and had >4 or more positive lymph nodes, no distant metastases, and no previous other malignancies. After complete surgical treatment, patients received conventional-dose anthracyclinebased chemotherapy or a high-dose scheme of anthracycline-based plus alkylating chemotherapy. We assessed clinical and (immuno)histological parameters to predict recurrence within 2 years.Results: Early failure occurred in 19% (n ‫؍‬ 137). Median survival after early failure was limited to 0.7 year. Estrogen and progesterone receptor negativity and visceral relapse predicted poor prognosis. Early failure was associated with young age, large tumors, high histological grade, angio-invasion, apical node metastasis, and >10 involved nodes. Estrogen receptor, progesterone receptor, and p27 negativity; HER2 overexpression; and p53 positivity also predicted early failure. The surgical or chemotherapy regimen and histological type did not. The same parameters except tumor size were associated with early death. Grade III, >10 involved nodes, and estrogen receptor negativity were independently associated with early failure and together identified a subset of patients (7%) with 3-fold increased early failure and 5-fold increased early death.Conclusions: Early failure is associated with poor survival. The combination of three commonly determined parameters constitutes a strong predictive model for early failure and death.

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Dose-response relationship of epirubicin-based first-line chemotherapy for advanced breast cancer: a prospective randomized trial.

Abstract: This study validates prospectively the concept of a dose-response relationship for an anthracycline-based chemotherapy in previously untreated advanced breast cancer.

Cited by 116 publications

References 28 publications

High-Dose Therapy with Autologous Bone Marrow Stem Cell Support in Primary and Metastatic Human Breast Cancer

High-Dose Therapy with Autologous Bone Marrow Stem Cell Support in Primary and Metastatic Human Breast Cancer

Granulocyte-macrophage colony-stimulating factor (GM-CSF) allows acceleration and dose intensity increase of CEF chemotherapy: a randomised study in patients with advanced breast cancer

Predicting Early Failure after Adjuvant Chemotherapy in High-Risk Breast Cancer Patients with Extensive Lymph Node Involvement

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