Neoadjuvant 5-fluorouracil, epirubicin and cyclophosphamide chemotherapy followed by docetaxel in refractory patients with locally advanced breast cancer

Abstract

Abstract. The objective of this study was to evaluate the clinical response of locally advanced breast cancer (LABC) to neoadjuvant (NA) chemotherapy with 5-fluorouracil, epirubicin and cyclophosphamide (FEC) and to study the role of docetaxel in patients who fail to respond to first-line chemotherapy. Patients were enrolled who had primary tumours without distant metastasis that were too extensive for conservative surgery. All underwent NA chemotherapy for breast cancer and thereafter surgery and/or radical radiotherapy. NA chemotherapy with FEC was administered to 88 patients between February 1998 and June 2005. A median of 6 cycles of FEC (range 1-8) was given, followed in 21 cases by a median of 4 cycles (range 2-6) of docetaxel. Where clinically established, with FEC the clinical complete response (cCR) was 22/81 (27%), clinical partial response (cPR) 41/81 (51%), clinical stable disease (cSD) 18/81 (22%). In patients where the response to FEC was regarded as insufficient, docetaxel was given. Response rates were cCR 3/21 (14%); cPR 10/21 (48%), cSD 8/21 (38%). There were 11 cases of pathological complete response (pCR), 9 in the FEC-only group and 2 in the docetaxel group. Following chemotherapy 49 (56%) patients underwent mastectomy, 32 (36%) breast conserving surgery and 5 (6%) radical radiotherapy, giving a breast conservation rate of 42%. Two patients died before receiving surgery or radical radiotherapy. The results show that neoadjuvant FEC is a reasonable NA therapy in breast cancer and that docetaxel is effective in FEC refractory cases. Only 8 of 81 (10%) assessable patients did not respond to any chemotherapy, giving an overall clinical response rate of 90%, which is comparable to studies in which taxanes were given irrespective of response to preceding therapy with antracycline including regimes. IntroductionNeoadjuvant chemotherapy is regarded as a useful procedure in the management of locally advanced (i.e. stage III) or large (≥3 cm) breast cancers. The aim of this approach is to induce tumour shrinkage in order to increase the possibility of breastconserving surgery in patients with potentially operable tumours and the response to neoadjuvant chemotherapy can be used to select subsequent adjuvant cytotoxic therapy.Studies comparing adjuvant with neoadjuvant chemotherapy, without adjustment on the basis of response, have found higher rates of breast conserving surgery but no significant differences in terms of disease-free or overall survival have been observed (1).Many studies have been published with various chemotherapy regimens, but we reasoned that the optimal choice of regimen would be to use as first-line the regimen we use as adjuvant therapy, i.e. the FEC regimen, and in those who fail to respond, switch to our second-line, non-cross-resistant therapy of choice, docetaxel. We felt that this approach would have two advantages: firstly, we could determine which patients were sensitive to one or other regimen, which would then be expected to inform about optimal adjuvant chemotherapy; ...

Clinical efficacy and value of redistributed subclavian arterial infusion chemotherapy for locally advanced breast cancer

“…With systemic chemotherapy, hematological toxicity over grade 3 appeared in 4%-65% of patients. 24,25 In our study it was 27.3%, and no other major complications were seen. RESAIC may be a treatment option in previously treated patients for the purpose of local control.…”

“…24,25 It is suggested that the presence of previous treatment infl uences the response rate, and it appeared to in our study. The response rate of previously untreated patients was 83.3%, which is similar to the rate with conventional systemic chemotherapy.…”

Neoadjuvant chemotherapy for locally advanced breast cancer: a single center experience

“…Pathologic partial response (pPR) defined as residual invasive disease after chemotherapy (according to RECIST criteria 30% decrease in larger diameter of the tumor size). Progressive disease was defined as at least 20% increase the tumor size or appearance of new metastasis [10].…”

Changes in aldehyde dehydrogenase-1 expression during neoadjuvant chemotherapy predict outcome in locally advanced breast cancer

“…In addition, the utility of markers, such as estrogen receptors (ER) and progesterone receptors (PR) status in the neoadjuvant setting, is not clear, although human epidermal growth factor receptor 2 ( HER2 ) gene amplification is associated with better response to neoadjuvant anti-HER2 therapy [11,12]. Given the heterogeneity of breast cancer at a phenotypic and molecular level, and the fact that only 15 to 20% of patients achieve a pCR [13-15], biomarkers that accurately predict a survival benefit from NAC remain a pressing and unmet clinical need.…”