Skip to main content
SpringerLink
Log in

Intensive short-term chemotherapy in patients with advanced breast cancer

  • Originalien
  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Summary

Aiming at a high complete remission rate with an intensive induction regimen, 27 patients with advanced breast cancer were given three cycles of VAC chemotherapy consisting of vinde-sine 3 mg/m2 i.v. on days 1 and 12, adriamycin 40 mg/m2 i.v. on days 1 and 12, and cyclophosphamide 200 mg/m2 p.o. on days 3–6 and 14–17 together with medroxyprogesterone acetate (MPA) 1,500 mg p.o. daily during the induction phase and 1,000 mg p.o. thereafter until relapse. These VAC double cycles were repeated twice with 3-weekly intervals for a total induction period of 15 weeks. In responders, including no change, the chemotherapy was discontinued thereafter, and the patients were observed until relapse with a maintenance therapy of MPA 1,000 mg p.o. daily.

A complete remission (CR) was achieved in 8 (29.6%) and a partial remission (PR) in 13 (48.2%) of the 27 patients (CR + PR 77.8%). A no change (NC) status was found in 6 patients (22.2%). There were no nonresponders. The median duration of the CR was 20 (5–42) months with two patients still in CR at 33 and 36 months, of the PR 8.3 (4–13.5) months, and of the NC 6.7 (2–13) months. The treatment was tolerated without life-threatening toxicity or interval prolongation by all patients. No dose-limiting cardiac toxicity was observed in these patients regularly controlled by left ventricular ejection fraction (LVEF). The high response rate of this intensive induction regimen warrants further investigation. Complete remission was achieved only in patients without previous chemotherapy, with marked tumor regression after the first chemotherapy cycle and when there was no extensive bone involvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ADR:

Adriamycin

CK:

Creatinine kinase

CK-MB:

Cardiac muscle specific isoenzymes

CMF:

Cyclophosphamide, methotrexate, 5-FU

CNS:

Central nervous system

CR:

Complete remission

CYC:

Cyclophosphamide

DFI:

Disease-free interval

ECG:

Electrocardiogram

LMF:

Chlorambucil, methotrexate, 5-FU

LVEF:

Left ventricular ejection fraction

MPA:

Medroxyprogesterone acetate

NC:

No change

PD:

Progressive disease

PR:

Partial remission

VAC:

Vincristine, adriamycin, cyclophosphamide

VEC:

Vincristine, epirubicin, cyclophosphamide

VDS:

Vindesine

WBC:

White blood cell count

References

  1. Ahmann FR, Pugh R (1985) Short-term treatment of poor prognosis metastatic breast cancer with three alternating chemotherapy regimens: a SWOG pilot study. Proc Am Soc Clin Oncol 4:C-264

    Google Scholar 

  2. Bezwoda WR, de Moor NG, Derman D, et al. (1979) Combination chemotherapy of metastatic breast cancer. Cancer 44:392–397

    Google Scholar 

  3. Blossey HC, Wander HE, Köbberling J, Nagel GA (1984) Pharmacokinetic and pharmacodynamic basis for the treatment of metastatic breast cancer with high-dose medroxyprogesterone acetate. Cancer 54:1208–1215S

    Google Scholar 

  4. Brambilla C, Delena M, Rossi A, et al. (1976) Response and survival in advanced breast cancer after two non-cross-resistant combinations. Br Med J I:801–804

    Google Scholar 

  5. Bull JM, Tormey DC, Li SH, et al. (1978) A randomized comparative trial of adriamycin vs methotrexate in combination drug therapy. Cancer 41:1649–1657

    Google Scholar 

  6. Creech RH, Catalano RB, Harris DT, et al. (1979) Low-dose chemotherapy of metastatic breast cancer with cyclophosphamide, adriamycin, methotrexate, 5-fluorouracil (CAMF) vs sequential cyclophosphamide, methotrexate, 5-fluorouracil (CMF) and adriamycin. Cancer 43:51–59

    Google Scholar 

  7. Decker DA, Ahmann DH, Bisel HF, Edmonson JH, Hahn RG, O'Fallon JR (1979) Complete responders to chemotherapy in metastatic breast cancer. J Am Med Assoc 242:2075–2079

    Google Scholar 

  8. Eyre HJ, Ward JH, Priebat DA (1983) Adult acute leukaemia: aggressive treatment improves survival. Cancer 51:2460–2468

    Google Scholar 

  9. Falkson G, Gelman RS, Tormey DC, et al. (1985) The Eastern Cooperative Oncology Group experience with cyclophosphamide, adriamycin and 5-fluorouracil (CAF) in patients with metastatic breast cancer. Cancer 56:219–224

    Google Scholar 

  10. Feldman L, Hortobagyi G, Buzdar A, Blumenschein G, Haynie T (1984) Duration of chemotherapy to achieve complete remission (CR) — a prognostic factor in metastatic breast cancer (MBC). Proc Am Soc Clin Oncol 3:C-475

    Google Scholar 

  11. Fisher B, Carbone P (1982) Breast cancer. In: Holland JF, Frei E (eds) Cancer medicine. Lea and Fiebiger, Philadelphia, pp 2025–2059

    Google Scholar 

  12. Gercovich FG, Morgenfeld E, Dragosky M, Muno H, Sorrentino M, Presman A, Martinez RE (1982) The effects of high parenteral doses of medroxyprogesterone acetate on myelopoiesis in patients with malignant disease. In: Cavalli F, McGuire FL, Pannuti F, Pellegrini A, Robustelli della Cuna G, (eds) Proceedings of the international symposium on medroxyprogesterone acetate. Excerpta-Medica, Amsterdam, pp 139–148

    Google Scholar 

  13. Goodyear M, Hryniuk W, Clark D, et al. (1985) Relationship of dose-intensity (DI) to outcome in chemotherapy of advanced breast carcinoma. Proc Am Soc Clin Oncol 4:C-236

    Google Scholar 

  14. Hayward JC, Carbone PO, Heuson JC, Kumaoka S, Segaloff A, Reubens RD (1977) Assessment of response to therapy in advanced breast cancer. Cancer 39:1289–1294

    Google Scholar 

  15. Henderson C, Canellos GP (1980) Cancer of the breast. The past decade (second of two parts). N Engl J Med 302:78–90

    Google Scholar 

  16. Henderson C, Gelman R, Canellos GP, Frei E (1981) Prolonged disease-free survival and advanced breast cancer treated with “super-CMF” adriamycin: a alternating regimen employing high dose methotrexate with citrovorum factor rescue. Cancer Treat Rep (Suppl 1) 65:67–75

    Google Scholar 

  17. Hirshaut Y, Kesselheim H (1983) Prolonged remissions of metastatic breast cancer achieved with a six-drug regimen of relatively low toxicity. Cancer 51:1998–2004

    Google Scholar 

  18. Hryniuk W, Bush H (1984) The importance of dose intensity in chemotherapy of metastatic breast cancer. J Clin Oncol 2:1281–1288

    Google Scholar 

  19. Hryniuk W, Goodyear M, Clark D, et al. (1985) Dose intensity predicts for eventual response to chemotherapy of advanced breast carcinoma. In: Proc 3rd European Conference on Clinical Oncology, Abstract 22, Stockholm

  20. Kiang DT, Kennedy BJ (1984) Survival data of chemoendocrine therapy in advanced breast cancer. Proc Am Soc Clin Oncol 3:C-466

    Google Scholar 

  21. Legha SS, Buzdar AU, Smith JL, et al. (1979) Complete remissions in metastatic breast cancer treated with combination drug therapy. Ann Intern Med 91:847–852

    Google Scholar 

  22. Lehrman DB, Budman DR, Bosworth JL, et al. (1985) Sequential combined modality treatment for stage II carcinoma for the breast. Proc Am Soc Clin Oncol 4:C-261

    Google Scholar 

  23. Meyer JS, McDivitt RW, Stone KR, et al. (1984) Practical breast cancer carcinoma cell kinetics: review and update. Breast Cancer Res Treat 4:79–88

    Google Scholar 

  24. Mortimer J, Livingston RB, Hardesty IJ, et al. (1984) Aggressive doxorubicin-containing regimen (prednisone, methotrexate, 5-FU, doxorubicin, and cyclophosphamide; PM-FAC) in disseminated estrogen receptor-negative breast cancer. Cancer Treat Rep 68:1017–1018

    Google Scholar 

  25. Muss HB, White DR, Richards F, et al. (1978) Adriamycin vs methotrexate in five-drug combination chemotherapy for advanced breast cancer. Cancer 42:2141–2148

    Google Scholar 

  26. Oye RK, Shapiro MF (1984) Reporting results from chemotherapy trials J Am Med Assoc 252:2722–2725

    Google Scholar 

  27. Pannuti F, Rossi AP, Marraro D, et al. (1980) Hormonal treatment. In: Twycross RG, Ventafridda V (eds) continuing care of terminal cancer patients. Pergamon Press, Oxford, pp 79–89

    Google Scholar 

  28. Powles RJ, Coombes RC, Smith IE et al. (1980) Failure of chemotherapy to prolong survival in a group of patients with metastatic breast cancer. Lancet II:580–582

    Google Scholar 

  29. Rainey JM, Jones SE, Salmon SE (1979) Combination chemotherapy for advanced breast cancer utilizing vincristine, adriamycin and cyclophosphamide (VAC). Cancer 43:66–71

    Google Scholar 

  30. Rosner D, Nemoto T (1985) Significance of first-line induction chemotherapy regimens in metastatic breast cancer (MBC). Proc Am Soc Clin Oncol 4:C-210

    Google Scholar 

  31. Sartorelli AC, Creasey WA (1982) Combination chemotherapy. In: Holland JF, Frei E (eds) Cancer medicine. Lea and Febiger, Philadelphia

    Google Scholar 

  32. Seeber S, Higi M, Niederle N, Schmidt CG (1981) Individualisierte Intervallverkürzung bei der chemotherapeutischen Indukationsbehandlung solider Tumoren. Dtsch Med Wochenschr 106:1741–1744

    Google Scholar 

  33. Sherlock P, Hartmann WH (1962) Adrenal steroids and the pattern of metastases of breast cancer. J Am Med Assoc 181:313–317

    Google Scholar 

  34. Tormey DC, Weinberg VE, Holland JF (1983) A randomized trial of 5 and 3 drug chemotherapy and chemoimmun-otherapy in women with operable node positive breast cancer. J Clin Incol 1:138

    Google Scholar 

  35. Wander HE, Bartsch HH, Blossey HC, and Nagel GA (1983) High-dose medroxyprogesterone acetate in metastatic breast cancer: preliminary report on three AIO (Association of Medical Oncology of the German Cancer Society) phase II trials. In: Campio L, Robustelli della Cuna G, Taylor RW (eds) Role of medroxyprogesterone acetate in endocrine-related tumors. Raven Press, New York, pp 85–93

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Zentrum Innere Medizin, Abteilung Hämatologie/Onkologie, Universität Göttingen, Germany

    H. -E. Wander & G. A. Nagel

  2. Zentrum Radiologie, Abteilung Nuklearmedizin, Universität Göttingen, Germany

    H. Luig & D. Emrich

Authors
  1. H. -E. Wander
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. A. Nagel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Luig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Emrich
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wander, H.E., Nagel, G.A., Luig, H. et al. Intensive short-term chemotherapy in patients with advanced breast cancer. Klin Wochenschr 65, 317–323 (1987). https://doi.org/10.1007/BF01745385

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01745385

Key words

Search

Navigation