medigraphic.com

2019, Número 1

<< Anterior Siguiente >>

Cir Cir 2019; 87 (1)


Epirubicina neoadyuvante con o sin docetaxel secuencial en el tratamiento del cáncer de mama avanzado: evaluación de la respuesta patológica completa y tolerabilidad de la quimioterapia

Ramírez-Torres N, Pérez-Puentes A, Moctezuma-Meza C, Victoria-Ayala R, Ortiz-Rodríguez K, Valenzuela-Martínez LA, Ayala-Anzures ME

Idioma: Español
Referencias bibliográficas: 33
Paginas: 59-68
Archivo PDF: 963.69 Kb.


RESUMEN

Objetivo: Evaluar la tasa de respuesta patológica completa (RPc) posterior a la quimioterapia neoadyuvante (QN) con antraciclinas con o sin taxanos en el manejo del cáncer de mama localmente avanzado (CMLA). Método: Se incluyeron pacientes con CMLA. Una cohorte recibió cuatro ciclos de FEC (5-fluorouracilo 500 mg/m2, epirubicina 75 mg/m2, ciclofosfamida 500 mg/m2) cada 3 semanas seguido por cuatro ciclos de docetaxel (D) 75 mg/m2 en infusión intravenosa de 1 hora cada 3 semanas. Otra cohorte recibió seis ciclos de FE100C (500, 100 y 600 mg/m2). Se realizó cirugía posterior a la quimioterapia. Resultados: No hubo diferencia estadísticamente significativa en las tasas de respuesta objetiva (78.5 vs. 85.0%; p = 0.299) ni en la respuesta clínica completa (20.6 vs. 33.3%; p = 0.103) para 4FEC→4D comparado con 6FE100C, respectivamente. En cambio, hubo una mejora significativa en la tasa de RPc (30.2 vs. 16.7%; p = 0.049) y en los ganglios linfáticos axilares negativos (51.6 vs. 35%; p = 0.03) para 4FEC→4D en comparación con 6FE100C, respectivamente. La toxicidad grave fue baja y no significativa en ambas cohortes. Los modelos multivariados de regresión logística mostraron que los principales predictores significativos para obtener una RPc fueron la QN con 4FEC→4D (odds ratio [OR]: 2.7; p = 0.019) y el estadio IIIA (OR: 3.8; p = 0.002). Conclusión: Este estudio mostró que el régimen 4FEC→4D con dosis convencional es muy activo y bien tolerado en pacientes con CMLA en nuestro hospital.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Buzdar AU, Singletary SE, Theriault RL, Booser DJ, Valero V, Ibrahim N, et al. Prospective evaluation of paclitaxel versus combination chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide as neoadjuvant therapy in patients with operable breast cancer. J Clin Oncol. 1999;17:3412-7.

  2. Mouret-Reynier MA, Abrial CJ, Ferrière JP, Amat S, Curé HD, Kwiatkowski FG, et al. Neoadjuvant FEC100 for operable breast cancer: eight- year experience at Centre Jean Perrin. Clin Breast Cancer. 2004;5:303-7.

  3. Smith IC, Heys SD, Hutcheon AW, Miller ID, Payne S, Gilbert FJ, et al. Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel. J Clin Oncol. 2002;20:1456-66.

  4. Bear HD, Anderson S, Brown A, Smith R, Mamounas EP, Fisher B, et al. The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2003;21:4165-74.

  5. Amat S, Bougnoux P, Penault-Llorca F, Fetissof F, Cure H, Kwiatkowski F, et al. Neoadjuvant docetaxel for operable breast cancer induces a high pathological response and breast-conservation rate. Br J Cancer. 2003;88:1339-45.

  6. Dieras V, Fumoleau P, Romieu G, Tubiana-Hulin M, Namer M, Mauriac L, et al. Randomized parallel study of doxorubicin plus paclitaxel and doxorubicin plus cyclophosphamide as neoadjuvant treatment of patients with breast cancer. J Clin Oncol. 2004;22:4958-65.

  7. Estevez LG, Gradishar WJ. Evidence-based use of neoadjuvant taxane in operable and inoperable breast cancer. Clin Cancer Res. 2004;10:3249-61.

  8. Evans TR, Yellowlees A, Foster E, Earl H, Cameron DA, Hutcheon AW, et al. Phase III randomized trial of doxorubicin and docetaxel versus doxorubicin and cyclophosphamide as primary medical therapy in women with breast cancer: an Anglo-Celtic Cooperative Oncology group study. J Clin Oncol. 2005;23:2988-95.

  9. von Minckwitz G, Raab G, Caputo A, Schütte M, Hilfrich J, Blohmer JU, et al. Doxorubicin with cyclophosphamide followed by docetaxel every 21 days compared with doxorubicin and docetaxel every 14 days as preoperative treatment in operable breast cancer: the GEPARDUO study of the German Breast Group. J Clin Oncol. 2005; 23:2676-85.

  10. Reitsamer R, Peintinger F, Prokop E, Hitzl W. Pathological complete response rates comparing 3 cycles versus 6 cycles of epidoxorubicin and docetaxel in the neoadjuvant setting of patients with stage II and III breast cancer. Anticancer Drugs. 2005;16:867-70.

  11. Steger GG, Galid A, Gnant M, Mlineritsch B, Lang A, Tausch C, et al. Pathologic complete response with six compared with three cycles of neoadjuvant epirubicin plus docetaxel and granulocyte colony-stimulating factor in operable breast cancer: results of ABCSG-14. J Clin Oncol. 2007;25:2012-8.

  12. Kaufmann M, von Minckwitz G, Bear HD, Buzdar A, McGale P, Bonnefoi H, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: new perspectives 2006. Ann Oncol. 2007;18:1927-34.

  13. Untch M, von Minckwitz G. Recent advances in systemic therapy. Advances in neoadjuvant (primary) systemic therapy with cytotoxic agents. Breast Cancer Res. 2009;11:203-10.

  14. Walker LG, Eremin JM, Aloysius MM, Vassanasiri W, Walker MB, El- Sheemy M, et al. Effects on quality of life, anti-cancer responses, breast conserving surgery and survival with neoadjuvant docetaxel: a randomised study of sequential weekly versus three-weekly docetaxel following neoadjuvant doxorubicin and cyclophosphamide in women with primary breast cancer. BMC Cancer. 2011;11:179-86.

  15. Kuerer HM, Newman LA, Smith TL, Ames FC, Hunt KK, Dhingra K, et al. Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol. 1999;17:460-9.

  16. Chollet P, Amat S, Cure H, de Latour M, Le Bouedec G, Mouret_Reyner MA, et al. Prognostic significance of a complete pathological response after induction chemotherapy in operable breast cancer. Br J Cancer. 2002;86:1041-6.

  17. Jones RL, Lakhani SR, Ring AE, Ashely S, Walsh G, Smith IE. Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma. Br J Cancer. 2006;94:358-62.

  18. Ramírez-Torres N, Pérez-Puentes A, Rivas-Ruiz R, Talavera JO, Astudillo- de la Vega H. Impacto pronóstico de la respuesta patológica completa y del estado ganglionar en pacientes con cáncer de mama avanzado tratadas con dosis alta de epirrubicina neoadyuvante. GAMO.2016;15:128-37.

  19. Bonneterre J, Dieras V, Tubiana-Hulin M, Bougnoux P, Bonneterre ME, Delozier T, et al. Phase II multicentre randomized study of docetaxel plus epirubicin vs 5- fluorouracil plus epirubicin and cyclophasphamide in patients with metastatic breast cancer. Br J Cancer. 2004;91:1466-71.

  20. Conte PF, Guarneri V, Bruzzi P, Prochilo T, Salvadori B, Bolognesi A, et al.; Gruppo Oncologico Nord Ovest. Concomitant versus sequential administration of epirubicin and paclitaxel as first-line therapy in metastatic breast carcinoma: results for the Gruppo Oncologico Nord Ovest randomized trial. Cancer. 2004;101:704-12.

  21. Nabholtz JM, Falkson C, Campos D, Szanto J, Martin M, Chan S, et al.; P. TAX 306 Study Group. Docetaxel and doxorubicin compared with doxorubicin and cyclophosphamide as first-line chemotherapy for metastatic breast cancer: results of a randomized, multicenter, phase III trial. J Clin Oncol. 2003;21:968-75.

  22. Jones SE, Erban J, Overmoyer B, Budd GT, Hutchins L, Lower E, et al. Randomized phase III study of docetaxel compared with paclitaxel in metastatic breast cancer. J Clin Oncol. 2005;23 5542-51.

  23. Fumoleau P, Chevallier B, Kerbrat P, Krakowski Y, Misset JL, Maugard- Louboutin C, et al. A multicentre phase II study of the efficacy and safety of docetaxel as first-line treatment of advanced breast cancer: report of the Clinical Screening Group of the EORTC. Ann Oncol.1996;7:165-71.

  24. Sessa C, Pagani O. Docetaxel and epirubicin in advanced breast cancer. Oncologist. 2001;6(Suppl 3):13-6.

  25. Singletary SE, Connolly JL. Breast cancer staging: working with the sixth edition of the AJCC Cancer Staging Manual. CA Cancer J Clin. 2006;56:37-47.

  26. National Cancer Institute. CTC Version 2.0 Publish Date: April 30, 1999.

  27. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer. 1981;47:207-14.

  28. Chevallier B, Roche H, Olivier JP, Chollet P, Hurteloup P. Inflammatory breast cancer. Pilot study of intensive induction chemotherapy (FEC-HD) results in a high histologic response rate. Am J Clin Oncol. 1993;16:223-8.

  29. Sánchez-Villegas A, Bes-Rastrollo M, Martínez-González MA. Regresión logística. En: Martínez-González MA, Sánchez-Villegas A, Toledo-Atucha EA, Faulin-Fajardo J, editores. Bioestadística amigable. 3.aed. Madrid: Elsevier España; 2014. p. 397-436.

  30. Valero V, Jones SE, Von Hoff DD, Booser DJ, Mennel RG, Ravdin PM, et al. A phase II study of docetaxel in patients with paclitaxel-resistant metastatic breast cancer. J Clin Oncol. 1998;16:3362-8.

  31. Iwata H, Nakamura S, Toi M, Shin E, Masuda N, Ohno S, et al. Interim analysis of a phase II trial of cyclophosphamide, epirubicin and 5-fluorouracil (CEF) followed by docetaxel as preoperative chemotherapy for early stage breast carcinoma. Breast Cancer. 2005;12:99-103.

  32. Therasse P, Mauriac L, Welnicka-Jaskiewicz M, Bruning P, Cufer T, Bonnefoi H, et al. Final results of a randomized phase III trial comparing cyclophosphamide, epirubicin and fluorouracil with a dose-intensified epirubicin and cyclophosphamide plus filgrastim as neoadjuvant treatment in locally advanced breast cancer: an EORT-NCIC-SAKK multicenter study. J Clin Oncol. 2003;21:843-50.

  33. Colleoni M, Viale G, Zahrieh D, Pruneri G, Gentilini O, Veronesi P, et al. Chemotherapy is more effective in patients with breast cancer no expressing steroid hormone receptors: a study of preoperative treatment. Clin Cancer Res. 2004;10:6622-8.




2020     |     www.medigraphic.com