Reinduction chemotherapy in T4 breast cancer high risk patients who failed achieving pCR after primary chemotherapy: 6 years survival in a pilot italian study (ICARO 1)

Ionta, Mt; Scanu,; Carta, Antonio; Vacca, D.; Contu, A.; Farris, Alton B.; Catino, A.; Palmeri, Sergio; Minerba, Luigi; Massidda, B.

doi:10.1016/s1359-6349(06)80383-6

European Journal of Cancer Supplements

2006

DOI: 10.1016/s1359-6349(06)80383-6

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Reinduction chemotherapy in T4 breast cancer high risk patients who failed achieving pCR after primary chemotherapy: 6 years survival in a pilot italian study (ICARO 1)

Mt Ionta¹,

Scanu Scanu²,

Antonio Carta³

et al.

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“…Individuals who did not achieve pCR at the time of surgery ( n = 35) were randomized to observation ( n = 28) or reinduction therapy with epirubicin and sequential docetaxel ( n = 7). At a median follow-up of 72 months, DFS and OS were significantly better in the reinduction group than in the observation group (100% versus 53%, P = 0.009; 100% versus 68%, P = 0.05, respectively) [ 19 ]. Although provocative, the numbers in this trial are too small for any definitive conclusions to be drawn.…”

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Clinical trial update: implications and management of residual disease after neoadjuvant therapy for breast cancer

2007

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Neoadjuvant chemotherapy for breast cancer has a well-established role in the management of patients with locally advanced or early stage disease. Multiple trials have demonstrated superior survival outcomes in individuals achieving a pathologic complete response at the time of definitive surgery, and sophisticated genetic methods may predict which patients will be in this category. Those with less than a pathologic complete response remain at significant risk of recurrent disease, and currently no further standard therapy exists. Ongoing studies of novel agents may lead to improved therapeutic outcomes for this high-risk population.Neoadjuvant or preoperative chemotherapy for operable breast cancer treatment was developed to achieve the goals of cytoreduction, with subsequent improvement in the ability to perform breast conservation, treatment of occult micrometastatic disease, and assessment of in vivo sensitivity to a treatment regimen [1]. Multiple trials have demonstrated the benefits and role of treatment with neoadjuvant; however, few studies have evaluated the management of patients after the completion of neoadjuvant therapy, especially those with a suboptimal response.Several large clinical trials have evaluated the role of neoadjuvant chemotherapy for breast cancer. National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18 randomized 1,523 patients with operable breast cancer to receive four cycles of adriamycin and cyclophosphamide (AC) either before or after definitive surgery. In the group treated with neoadjuvant, a rate of pathologic complete response (pCR) in the breast of 13% was observed, with a significantly higher rate of breast conservation (67% versus 60%; P = 0.002) At a median follow-up of 9 years, comparison between the groups treated with neoadjuvant and with adjuvant demonstrated no differences in either disease-free survival (DFS) or overall survival (OS). However, when segregated by pathologic response to treatment with neoadjuvant, individuals achieving a pCR experienced significantly improved outcomes compared with non-pCR subjects, including 9-year DFS (75% versus 58%) and OS (85% versus 73%), and a 50% decrease in the risk of death compared with all other pathologic outcomes (relative risk 0.50, 95% confidence interval 0.32 to 0.78) [2,3]. In a similar study, the European Organization for Research and Treatment of Cancer (EORTC) randomized 698 subjects to anthracycline-based chemotherapy before or after surgery. Again, despite there being no differences in DFS or OS between the neoadjuvant and adjuvant groups, the pCR subgroup, defined as no residual invasive tumor in breast or lymph node tissue, did show improved OS (hazard ratio (HR) 0.86, 95% confidence interval 0.77 to 0.96, P = 0.008) [4]. To investigate the role of exposure to neoadjuvant taxane, the NSABP randomized 2,411 subjects in study B-27 to neoadjuvant AC alone, to neoadjuvant AC and docetaxel before surgery, or to neoadjuvant AC with adjuvant docetaxel after surgery. The addition of the preoperative...

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Clinical trial update: implications and management of residual disease after neoadjuvant therapy for breast cancer

2007

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Reinduction chemotherapy in T4 breast cancer high risk patients who failed achieving pCR after primary chemotherapy: 6 years survival in a pilot italian study (ICARO 1)

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Clinical trial update: implications and management of residual disease after neoadjuvant therapy for breast cancer

Clinical trial update: implications and management of residual disease after neoadjuvant therapy for breast cancer

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