TY - JOUR
T1 - Phase 2 trial of primary systemic therapy with doxorubicin and docetaxel followed by surgery, radiotherapy, and adjuvant chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil based on clinical and pathologic response in patients with stage IIB to III breast cancer
T2 - Long-term results from the University of Texas M. D. Anderson Cancer Center Study ID97-099
AU - Alvarez, Ricardo H.
AU - Booser, Daniel J.
AU - Cristofanilli, Massimo
AU - Sahin, Aysegul A.
AU - Strom, Eric A.
AU - Guerra, Laura
AU - Kau, Shu Wan
AU - Gonzalez-Angulo, Ana M.
AU - Hortobagyi, Gabriel N.
AU - Valero, Vicente
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/3/1
Y1 - 2010/3/1
N2 - BACKGROUND: This study was performed to evaluate the outcomes of patients with locally advanced breast cancer (LABC)whowere treatedwith amultidisciplinary approach including primary systemic chemotherapy and noncross-resistant adjuvant chemotherapy. METHODS: Patients with LABC received 4 or 6 cycles of doxorubicin and docetaxel (DT) as primary systemic chemotherapy (PST) every 21 days. Patients with adequate response underwent surgery followed by adjuvant chemotherapy according to pathologic response: complete (pCR), 2 more cycles of DT; partial (pPR), 2 more cycles of DT followed by 6 cycles of cyclophosphamide,methotrexate, and 5-fluorouracil (5-FU) (CMF); andminor (pMR), 6 cycles of CMF. Patients then received radiation and tamoxifen (hormone receptor-positive patients only). RESULTS: Eighty-eight patients were evaluable. Seventy-four patients had an adequate response to DT and were considered operable, and 72 underwent surgery.Ten patients (13.9%) achieved a pCR, 22 (30.5%) achieved a pPR, and 40 achieved a pMR (55.5%). Fourteen patientswere considered nonoperable after DTand underwent salvage CMF therapy. Five of these patients underwent surgery and 1 had achieved a pCR. The estimated 5-year recurrence-free survival (RFS) rates for patients with pCR, pPR, and pMR were 80%, 77%, and 59%, respectively, and the estimated 5-year overall survival (OS) rates were 90%, 91%, and 74%, respectively. The 5-year OS rates were 82% for initially operable and 21% for initially inoperable patients (P ≤ .001) CONCLUSIONS: Multidisciplinary therapy that includes PSTwith DTand adjuvant therapy with CMF administered according to the clinical and pathologic response is associated with high long-term RFS and OS rates in patients with LABC. Clinical or pathologic PR or CR to DT predicts improved RFS and OS.
AB - BACKGROUND: This study was performed to evaluate the outcomes of patients with locally advanced breast cancer (LABC)whowere treatedwith amultidisciplinary approach including primary systemic chemotherapy and noncross-resistant adjuvant chemotherapy. METHODS: Patients with LABC received 4 or 6 cycles of doxorubicin and docetaxel (DT) as primary systemic chemotherapy (PST) every 21 days. Patients with adequate response underwent surgery followed by adjuvant chemotherapy according to pathologic response: complete (pCR), 2 more cycles of DT; partial (pPR), 2 more cycles of DT followed by 6 cycles of cyclophosphamide,methotrexate, and 5-fluorouracil (5-FU) (CMF); andminor (pMR), 6 cycles of CMF. Patients then received radiation and tamoxifen (hormone receptor-positive patients only). RESULTS: Eighty-eight patients were evaluable. Seventy-four patients had an adequate response to DT and were considered operable, and 72 underwent surgery.Ten patients (13.9%) achieved a pCR, 22 (30.5%) achieved a pPR, and 40 achieved a pMR (55.5%). Fourteen patientswere considered nonoperable after DTand underwent salvage CMF therapy. Five of these patients underwent surgery and 1 had achieved a pCR. The estimated 5-year recurrence-free survival (RFS) rates for patients with pCR, pPR, and pMR were 80%, 77%, and 59%, respectively, and the estimated 5-year overall survival (OS) rates were 90%, 91%, and 74%, respectively. The 5-year OS rates were 82% for initially operable and 21% for initially inoperable patients (P ≤ .001) CONCLUSIONS: Multidisciplinary therapy that includes PSTwith DTand adjuvant therapy with CMF administered according to the clinical and pathologic response is associated with high long-term RFS and OS rates in patients with LABC. Clinical or pathologic PR or CR to DT predicts improved RFS and OS.
KW - Anthracylines
KW - Breast cancer
KW - CMF regimen
KW - Inflammatory breast cancer
KW - Locally advanced breast cancer
KW - Primary systemic therapy
KW - Taxanes
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U2 - 10.1002/cncr.24901
DO - 10.1002/cncr.24901
M3 - Article
C2 - 20082452
AN - SCOPUS:77149154662
SN - 0008-543X
VL - 116
SP - 1210
EP - 1217
JO - Cancer
JF - Cancer
IS - 5
ER -