Neoadjuvant treatment for locally advanced breast cancer. Comparacion of two schemes based on docetaxel-epirubicin vs. 5-fluorouracil-epirubicin-cyclophosphamide

Ana Olivia Cortés-Flores; Gilberto Morgan-Villela; Juan Manuel Castro-Cervantes; Gonzalo Vázquez-Camacho; Clotilde Fuentes-Orozco; Alejandro González-Ojeda

2008, Number 1

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Cir Cir 2008; 76 (1)

Neoadjuvant treatment for locally advanced breast cancer. Comparacion of two schemes based on docetaxel-epirubicin vs. 5-fluorouracil-epirubicin-cyclophosphamide

Cortés-Flores AO, Morgan-Villela G, Castro-Cervantes JM, Vázquez-Camacho G, Fuentes-Orozco C, González-Ojeda A

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Language: Spanish
References: 25
Page: 23-28
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ABSTRACT

Background: Breast cancer is the most common type of cancer in women worldwide. In Mexico, › 34% of patients are in locally advanced stages at the time of diagnosis. Neoadjuvant chemotherapy is administered to control local disease, make surgical resection possible and increase the possibility of breast tissue conservation.
Methods: We performed a double-blind, randomized clinical trial in patients with locally advanced breast cancer (stages IIB and IIIA) with two therapy schemes; 5-fluorouracil-epirubicin-cyclophosphamide (control group) vs. docetaxel-epirubicin (study group). Both were indicated in three preoperative cycles, and patients were submitted afterwards to surgery. Pathological response was measured.
Results: Forty one patients were included in our study. They were distributed in two homogeneous groups: 21 for the control group and 20 for the study group. Dimensional pathological response was higher in the study group than in the control one (p ‹ 0.05). Five patients in the control group and 11 patients of the study group experienced complete pathological response (p ‹ 0.05). The most common secondary events were leucopenia, neutropenia and fever. Morbidity, number of lymph nodes, disease-free survival and general survival did not show significant differences between groups. No mortality was reported during a minimum follow-up of 28 months.
Conclusions: Our results confirm the effectiveness of docetaxel-epirubicin to obtain complete pathological response. Neoadjuvant therapy has been shown to increase the pathological response when a taxane is added to an anthracycline. This combination presented more secondary events, but they can be effectively treated with medical management. Neoadjuvant docetaxel-epirubicin followed by surgery is an appropriate regimen for patients with locally advanced breast cancer.

REFERENCES

1. Neal AJ, Hoskin PJ. Clinical Oncology. Basic Principles and Practice. 3rd ed. London: Arnold;2003. pp. 68-85.
2. Dirección General de Epidemiología. Registro Nacional de Cáncer. México: Secretaría de Salud; 1996.
3. Valero V, Buzdar A, Hortobagyi G. Locally advanced breast cancer. Oncologist 1996;1:8-17.
4. Harris JR, Lippman ME, Veronesi U. Breast cancer. N Engl J Med 1992;327:319-328.
5. Wolff AC, Davidson NE. Preoperative therapy in breast cancer: lessons from the treatment of locally advanced disease. Oncologist 2002;7:239-245.
6. Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 1998;16:2672-2685.
7. Charfare H, Limongelli S, Puruschotham AD. Neoadjuvant chemotherapy in breast cancer. Br J Surg 2005;92:14-23.
8. Insa A, Chirivella I, Lluch A. Tratamiento neoadyuvante del cáncer de mama operable. Med Clin (Barc) 2006;126:295-303.
9. Sachelarie I, Groosbard ML, Chadha M, Feldman S, Ghesani M, Blum RH. Primary systemic therapy of breast cancer. Oncologist 2006;11:574-589.
10. Guarneri V, Frassoldati A, Giovannelli S, Borghi F, Conte P. Primary systemic therapy for operable breast cancer: a review of clinical trials and perspectives. Cancer Lett 2007;248:175-185.
11. von Minckwitz G. Docetaxel/anthracycline combinations for breast cancer treatment. Expert Opin Pharmacother 2007;8:485-495.
12. Mieog JSD, van der Hage JA, van de Velde CJH. Preoperative chemotherapy for women with operable breast cancer (review). Cochcrane database of Systematic Reviews 2007; 2. Art. No: 10.1002/14651858.CD005002.pub.2
13. National Cancer Institute. www.cancer.gov
14. Nabholtz JM, Riva A. Taxane/anthracycline combinations: setting a new standard in breast cancer? Oncologist 2001;6(suppl):5-12.
15. de Matteis A, Nuzzo F, D’Aiuto G, et al. Docetaxel plus epidoxorubicin as neoadjuvant treatment in patients with large operable or locally advanced carcinoma of the breast: a single-center, phase II study. Cancer 2002;94:895-901.
16. Ravdin PM, Burris HA, Cook G, et al. Phase II trial of docetaxel in advanced anthracycline-resistant or anthracenedione-resistant breast cancer. J Clin Oncol 1995;13:2879-2885.
17. Nabholtz JM, Senn HJ, Bezwoda WR, et al. Prospective randomized trial of docetaxel versus mitomycin plus vinblastine in patients with metastatic breast cancer progressing despite previous anthracycline-containing chemotherapy. 304 Study Group. J Clin Oncol 1999;17:1413-1424.
18. Chan S, Friedrichs K, Noel D, et al. Prospective randomized trial of docetaxel versus doxorubicin in patients with metastatic breast cancer. The 303 Study Group. J Clin Oncol 1999;17:2341-2354.
19. Gradishar WJ. Primary (neoadjuvant) chemotherapy with docetaxel in breast cancer. Clin Breast Cancer 2001;2:S31-35.
20. Sessa C, Pagani O. Docetaxel and epirubicin in advanced breast cancer. Oncologist 2001;6(suppl):13-16.
21. Gradishar WJ, Wedam SB, Jahanzeb M, et al. Neoadjuvant docetaxel followed by adjuvant doxorubicin and cyclophosphamide in patients with stage III breast cancer. Ann Oncol 2005;16:1297-1304.
22. Sjostrom J, Blomqvist C, Mouridsen H, et al. Docetaxel compared with sequential methotrexate and 5-fluorouracil in patients with advanced breast cancer after anthracycline failure: a randomized phase III study with crossover on progression by the Scandinavian Breast Group. Eur J Cancer 1999;35:1194-1201.
23. Reitsamer R, Peintinger F, Prokop E, Hitzl W. Pathological complete response rates comparing 3 versus 6 cycles of epidoxorubicin and docetaxel in the neoadjuvant setting of patients with stage II and III breast cancer. Anticancer Drugs 2005;16:867-870.
24. Breslin TM, Cohen L, Sahin A, et al. Sentinel lymph node biopsy is accurate after neoadjuvant chemotheraphy for breast cancer. J Clin Oncol 2000;18:3480-3486.
25. Tfayli A, Holter J, Brova A, et al. Activity of combination chemotherapy docetaxel and epirubicin as neoadjuvant therapy for women with breast cancer. Anticancer Res 2006;26:4911-4916.