Significantly higher pathological complete remission (PCR) rate following neoadjuvant therapy with trastuzumab (H), paclitaxel (P), and anthracycline-containing chemotherapy (CT): Initial results of a randomized trial in operable breast cancer (BC) with HER/2 positive disease

Buzdar, Aman U.; Hunt, Kelly K.; Smith, Tracey L.; Francis, Deborah; Ewer, Michael S.; Booser, D. J.; Singletary, Eva; Buchholz, Thomas A.; Sahin, A.; Hortobagyi, G. N.

doi:10.1200/jco.2004.22.14_suppl.520

Cited by 19 publications

(23 citation statements)

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“…Cardiac monitoring with LVEF and cardiac troponin T, a sensitive and specific marker of myocardial injury, was performed in all patients. There was no evidence of elevated cardiac troponin T levels, and in two patients, transient LVEF reductions returned to baseline, thus demonstrating that the sequential administration of epirubicin and trastuzumab is both feasible and well tolerated; a remarkably high pathological response rate was identified with a combination of paclitaxel followed by FEC75 in a preliminary analysis [49]. The BCIRG 006 and the NCCTG N9831 trials using trastuzumab following anthracycline-based chemotherapy recently reported cardiac safety data (Table 4).…”

Section: Epirubicin's Safety Profilementioning

confidence: 88%

“…The rationale is that "downsizing" a large T2 or T3 lesion to achieve a pCR may result in better long-term survival, while it also affords the opportunity to evaluate the chemoresponsiveness of the patient to a specific regimen. HER-2-positive patients who received neoadjuvant therapy consisting of sequential epirubicin-based chemotherapy (FEC90) with paclitaxel followed by trastuzumab had significantly higher rates of pathologic complete remission than patients who did not receive trastuzumab (67% versus 25%; p = .02) [32]. Larger numbers of patients are being enrolled in neoadjuvant clinical trials based on these early but promising results.…”

Section: Other Patient Subsetsmentioning

confidence: 99%

“…Trastuzumab, a humanized hybrid monoclonal antibody that selectively binds to the extracellular domain of HER-2, has become an important component of breast cancer therapy regimens in metastatic breast cancer and more recently in preoperative therapy [32]. Trastuzumab also produced better survival in patients who had metastatic breast cancer overexpressing HER-2 when it was administered in combination with paclitaxel or docetaxel, or combinations of doxorubicin and cyclophosphamide and other cytotoxic drugs [34,35].…”

Section: Her-2-targeted Therapymentioning

confidence: 99%

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Adjuvant Chemotherapy for Early Breast Cancer: Optimal Use of Epirubicin

Glück

2005

The Oncologist

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Learning ObjectivesAfter completing this course, the reader will be able to:1. Discuss the value of adjuvant chemotherapy in early breast cancer.2. Critically assess the use of anthracyclines as part of adjuvant chemotherapy.3. Describe the delivery of anthracyclines regarding dose, dose intensity, and dose density. Access and take the CME test online and receive 1 AMA PRA category 1 credit at CME.TheOncologist.com CME CME

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Section: Epirubicin's Safety Profilementioning

confidence: 88%

Section: Other Patient Subsetsmentioning

confidence: 99%

Section: Her-2-targeted Therapymentioning

confidence: 99%

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Adjuvant Chemotherapy for Early Breast Cancer: Optimal Use of Epirubicin

Glück

2005

The Oncologist

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“…Recently, high pathological complete remission (pCR) rates have been reported by weekly application of paclitaxel [8] or the addition of trastuzumab to cytotoxic treatment [9]; however, these results have to be confirmed by larger, multicenter trials.…”

Section: What Regimen Should Be Used?mentioning

confidence: 99%

Principles of preoperative chemotherapy

Minckwitz

2004

Breast Cancer Online

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Efficacy of preoperative (primary, neoadjuvant) systemic chemotherapy significantly improved over the last two decades. Only about 3% of patients reached a pathological complete remission after preoperative treatment with cyclophosphamide, methotrexate and 5-fluorouracil in the late 1980s, whereas today up to 18% have no viable tumour cell detected at histological examination when taxane-containing regimens, for example adriamycin/cyclophosphamide followed by docetaxel or docetaxel/adriamycin/cyclophosphamide, are being used. This improvement has implications on current treatment recommendations and should be considered when this approach gains a broader use in routine practice.

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“…The data in the literature shows rates of complete pathological responses that sometimes exceeds 60% [1,2]. This finding is closely related to favorable long-term outcomes, and it is a valuable end point [3].…”

Section: Introductionmentioning

confidence: 96%

Contrast-enhanced US and MRI for assessing the response of breast cancer to neoadjuvant chemotherapy

Corcioni

Santilli

Quercia

et al. 2008

Journal of Ultrasound

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KEYWORDSBreast ultrasonography; Breast cancer; Contrast media; Contrast-enhanced US; MRI.Abstract Purpose: To evaluate the response of breast cancers to neoadjuvant chemotherapy (NAC) with second-generation contrast-enhanced ultrasound (CEUS) and magnetic resonance (MR). Materials and Methods: We studied 16 women aged 33e74 years (mean, 53 years; median, 38 years) with locally advanced breast carcinoma or large operable breast cancer (>2 cm; T2eT4, N0eN3, M0) that had been detected by mammography, conventional ultrasonography, and biopsy. CEUS (with SonoVue, 5 ml) and MR (with Gd-DTPA; 0.2 mM/kg) were performed under blinded conditions before, during, and after 6e8 cycles of NAC. Lesions were measured and time/signal intensity (T/SI) curves were calculated during both the examinations. The data obtained were analyzed in light of the results of surgical pathology. Results: Six patients had complete responses manifested by the disappearance of enhancement at both CEUS and MR. Six others had partial responses (reduction of lesion enhancement >50%). In 5/6, T/SI curves obtained with CEUS and MR were both indicative of malignancy (flat curves at CEUS, type I curves at MR); the sixth had a discontinuous curve at CEUS and a type II curve at MR. Four patients had lesional enhancement reductions of <50%. In 3, concordant pictures emerged from the analysis of T/SI curves (discontinuous curves in CEUS, type II and III curves in MR); the fourth had a flat CEUS curve and a type I MR curve. Responses to NAC classified on the basis of MR and CEUS findings showed good correlation with the pathological response. Conclusions: T/SI curves recorded during CEUS correlate with those obtained during MR and may be a valid index of response to the therapy. Sommario Scopo: Valutare la risposta alla chemioterapia neoadiuvante (NAC) in pazienti con carcinoma della mammella confrontando l'ecografia con mezzo di contrasto di seconda generazione (CEUS) con la risonanza magnetica (RM). Materiali e metodi: Sedici pazienti (età fra 33 e 74 anni; media di 53 anni; mediana 38 anni) affette da carcinoma mammario localmente avanzato o operabile ma superiore a 2 cm (T2-T4; N0-N3; M0), già diagnosticato con mammografia, ecografia convenzionale e biopsia, sono state monitorate con CEUS (con SonoVue, 5 ml) e RM (con Gd-DTPA, 0,2 mM/kg). Le indagini sono state effettuate in cieco: prima di iniziare il trattamento, dopo 4 cicli di terapia e prima dell'intervento chirurgico. Con entrambe le metodiche sono state calcolate le dimensioni delle lesioni e le curve tempo/intensità di segnale (T/IS). I dati ottenuti sono stati confrontati con l'esame patologico eseguito al termine della terapia sul pezzo operatorio. Risultati: Sei su 16 pazienti hanno mostrato sia alla CEUS sia alla RM una risposta completa alla NAC con scomparsa di enhancement. In 6 su 16 pazienti si è riscontrata una riduzione parziale dell'enhancement delle lesioni (>50%) con curve T/IS concordanti fra CEUS e RM in cinque casi (in particolare curve piatte alla CEUS e di tipo I alla RM); nel se...

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Significantly higher pathological complete remission (PCR) rate following neoadjuvant therapy with trastuzumab (H), paclitaxel (P), and anthracycline-containing chemotherapy (CT): Initial results of a randomized trial in operable breast cancer (BC) with HER/2 positive disease

Cited by 19 publications

References 0 publications

Adjuvant Chemotherapy for Early Breast Cancer: Optimal Use of Epirubicin

Adjuvant Chemotherapy for Early Breast Cancer: Optimal Use of Epirubicin

Principles of preoperative chemotherapy

Contrast-enhanced US and MRI for assessing the response of breast cancer to neoadjuvant chemotherapy

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