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High complete pathological response in locally advanced breast cancer using paclitaxel and cisplatin

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Abstract

Background.In an earlier study, we have demonstrated a high response rate in metastatic breast cancer using paclitaxel (P) and cisplatin (C). A phase II study using the same regimen (PC) has been conducted in locally advanced breast cancer (LABC).

Methods.A total of 72 consecutive patients with non-inflammatory LABC (T2 ≥ 4 cm, T3 or T4, N0–N2, M0). Patients were scheduled to receive 3–4 cycles of the neoadjuvant PC (paclitaxel 135 mg/m2 and cisplatin 75 mg/m2 on day 1) every 21 days. Patients were then subjected to surgery and subsequently received 6 cycles of FAC (5-fluorouracil 500 mg/m2, doxorubicin 50 mg/m2, and cyclophosphamide 500 mg/m2) or 4 cycles of AC (doxorubicin 60 mg/m2, and cyclophosphamide 600 mg/m2). Patients then received radiation therapy, and those with hormone receptor positive tumors were given adjuvant tamoxifen intended for 5 years.

Results.The median age was 39 years (range, 24–78). Clinically, 7%, 58%, and 35% of patients had T2 ≥ 4 cm, T3, and T4, respectively. Disease stage at diagnosis was IIB (33%), IIIA (27%), and IIIB (40%). Complete and partial clinical response to PC was demonstrated in 13 (18%), and 52 (72%) patients, respectively. Of those patients with evaluable pathologic response (68 patients), complete pathologic response (pCR) was achieved in 15 (22%) patients. At a median follow-up of 22 (± 3.5) months, 58 (81%) were alive with no recurrence, nine (12%) were alive with evidence of disease, and five (7%) were dead. None of the patients achieving pCR has developed any relapse. The median overall survival has not been reached for all 72 patients with a projected 3-year survival (± SE) of 90% (± 4%). The median progression-free survival (PFS) was 42.1 (± 4.8) months with a projected PFS of 74% ± 7% at 3-years (for 68 patients).

Conclusions.PC regimen in LABC produced a high pCR. The contribution of the other added modalities to survival could not be assessed.

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References

  1. De Lena M, Varini M, Zucali R, Viganotti G, Valaguss P, Veronesi U et al.: Multimodal treatment for locally advanced breast cancer. Result of chemotherapy-radiotherapy versus chemotherapy-surgery. Cancer Clin Trials 4: 229–236, 1981

    Google Scholar 

  2. Hortobagyi GN, Ames FC, Buzdar QU, Kau SW, McNeese MD, Paulus D et al.: Management of stage III primary breast cancer with primary chemotherapy, surgery and radiation therapy. Cancer 62: 2507–2516, 1988

    Google Scholar 

  3. Kuerer H, 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 17: 460–469, 1999

    Google Scholar 

  4. Valagussa P, Zambetti M, Bonadonna G, Zucali R, Mezzanotte G, Veronesi U.: Prognostic factors in locally advanced noninflammatory breast cancer. Long-term results following primary chemotherapy. Breast Cancer Res Treat 15: 137–147, 1990

    Google Scholar 

  5. Smith IE, al-Moundhri M.: Primary chemotherapy in breast cancer. Biomed Pharmacother 52: 116–121, 1998

    Google Scholar 

  6. Smith IE, Jones AL, O'Brien ME, McKinna JA, Sacks N, Baum M.: Primary medical (neo-adjuvant) chemotherapy for operable breast cancer. Eur J Cancer 29A: 1796–1799, 1993

    Google Scholar 

  7. Smith IE, Walsh G, Jones A, Prendivilli J, Johnston PJ, Ramage F et al.: High complete remissions with primary (neoadjuvant) infusional chemotherapy for large early breast cancer. J Clin Oncol 13: 424–429, 1995

    Google Scholar 

  8. Bonadonna G, Valagussa P, Brambilla C, Ferrari L, Moliterni A, Tereniziani M et al.: Primary chemotherapy in operable breast cancer. Eight-year experience atMilan Cancer Institute. J Clin Oncol 16: 93–100, 1998

    Google Scholar 

  9. Anderson ED, Forrest AP, Hawkins RA, Anderson TJ, Leonard RC, Chetty U: Primary systemic therapy for operable breast cancer. Br J Cancer 63: 561–566, 1991

    Google Scholar 

  10. Fisher B, Bryant J, Wolmark N, Mamounas E, Brown A, Fisher ER: Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 16: 2672–2685, 1998

    Google Scholar 

  11. Powles TJ, Hickish TF, Makris A, Ashley SE, O'Brien ME, Tidy VA et al.: Randomized trial of chemoendocrine therapy started before or after surgery for treatment of primary breast cancer. J Clin Oncol 13: 547–552, 1995

    Google Scholar 

  12. Scholl SM, Foourquet A, Asselian B, Pierga JY, Vilcoq JR, Durand JC et al.: Neoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumors too large for breast conservative surgery: preliminary results of a randomized trial. Eur J Cancer 30A: 645–652, 1994

    Google Scholar 

  13. von Minckwitz G, Dan Costa S, Eiermann W, Blohmer J, Tulusan AH, Jackish C, Kaufmann M: Maximized reduction of primary breast tumor size using preoperative chemotherapy with doxorubicin and docetaxel. J Clin Oncol 17: 1999–2005, 1999

    Google Scholar 

  14. Ezzat A, Raja MA, Berry J, Bazarbashi S, Zwann F, Rahal M et al.: A phase II trial of circadian-timed paclitaxel and cisplatin therapy in metastatic breast cancer. Ann Oncol 8: 663–667, 1997

    Google Scholar 

  15. Frasci G, D'Aiuto G, Comella P, Apicella A, Thomas R, Capasso I, Di Bonito M, Carteni G, Biglietto M, De Lucia L, Maiorino L, Piccolo S, Bianchi U, D'Aniello R, Lapenta L, Comella G: Cisplatin-epirubicin-paclitaxel weekly administration in advanced breast cancer: a phase I study of the Southern Italy Cooperative Oncology Group. Breast Cancer Res Treat, 56: 239–252, 1999

    Google Scholar 

  16. Kourousis C, Kakolyris S, Androulakis N, Heras P, Vlchonicolis J, Vamvakas L et al.: Salvage therapy with paclitaxel, vinorelbine, and cisplatin (PVC) in anthracyclineresistant advanced breast cancer. Am J Clin Oncol 21: 226–232, 1998

    Google Scholar 

  17. Hortobagyi GN: Paclitaxel-based combination chemotherapy for breast cancer. Oncology 11 (3 Supp 2): 29–37, 1997

    Google Scholar 

  18. Volm M, Formenti S, Symmans F, Downey A, Muggia F: Neo-adjuvant paclitaxel for locally advanced breast cancer (LABC): preliminary results. Proc Am Soc Clin Oncol 17: 695 (Abstract), 1998

    Google Scholar 

  19. Schwartzberg LS, Birch R, Weaver CH, Campos L, Buckner CD: High pathological complete response (CR) rate to sequential doxorubicin and paclitaxel primary chemotherapy for locally advanced breast cancer (LABC). Proc Am Soc Clin Oncol 17: 431 (Abstract) 1998

    Google Scholar 

  20. Morrell LE, Lee YJ, Hurley J, Arias M, Mies C, Richman SP et al.: A phase II trial of neoadjuvant methotrexate, vinblastin, doxorubicin, and cisplatin in the treatment of patients with locally advanced breast carcinoma. Cancer 82: 503–511, 1998

    Google Scholar 

  21. Ezzat A, Raja M, Rostom A, Zwaan F, Akhtar M, Bazarbashi S et al.: An overview of breast cancer. Ann Saudi Med 17: 10–15, 1997

    Google Scholar 

  22. Ibrahim EM, Al-Mulhim FA, Al-Amri A, Al-Muhanna FA, Ezzat A, Ajarim D et al.: Breast cancer: Data from the Eastern Province of Saudi Arabia. Med Oncol 15: 241–247, 1998

    Google Scholar 

  23. Ezzat A, Ibrahim EM, Raja M, Al-Sobhi S, Rostom A, Stuart RK: Locally advanced disease of the breast: high proportion of stage III disease in a young population. Med Oncol (in press).

  24. Harmanek P, Sobin LH: TNM Classification of Malignant Tumors. UICC International Union Against Cancer. Berlin, Germany, Springer-Verlag, 1987

    Google Scholar 

  25. American Joint Committee on Cancer: Manual for Staging of Cancer, (4th edition). Philadelphia, PA, Lippincott pp 149–154, 1992

    Google Scholar 

  26. Haagensen CD, Stout AP: Carcinoma of the breast: Criteria of inoperability. Ann Surg 118: 859–870, 1943

    Google Scholar 

  27. Feldman LD, Hortobagyi GN, Buzdar AU, Ames FC, Blumenschein GR: Pathological assessment to induction chemotherapy in breast cancer. Cancer Res 46: 2578–2581, 1986

    Google Scholar 

  28. Fleiss JL: Statistical Methods for Rates and Proportions, 2nd edition. New York, Macmillan, 1981

    Google Scholar 

  29. Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Amer Statist Ass 53: 457–481, 1958

    Google Scholar 

  30. Brookmeyer R, Crowley J: A confidence interval for the median survival time. Biometrics 38: 29–41, 1982

    Google Scholar 

  31. Mantel N: Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50: 163–170, 1966

    Google Scholar 

  32. Cox DR, Oakes D: Regression models and life tables (with discussion). J Roy Statist Soc B34: 187–220, 1972

    Google Scholar 

  33. Kalbfleisch JD, Prentice RL: The Statistical Analysis of Failure Time Data. Wiley, New York, 1980

    Google Scholar 

  34. Dixon WJ, Brown MB, Engelman L, Jennrich RI: BMDP Statistical Software Manual. University of California Press, Berkeley, 1990

    Google Scholar 

  35. Zucali R, Uslemghi C, Kenda R, Bonadonna G: Natural history and survival of inoperable breast cancer treated with radiotherapy followed by radical mastectomy. Cancer 37: 1422–1431, 1976

    Google Scholar 

  36. Bruckman J, Harris J, Levene M, Chaffey JT, Hellman S: Results of treating stage III carcinoma of the breast by primary radiation therapy. Cancer 43: 985–993, 1979

    Google Scholar 

  37. Ezzat A, Rahal M, Raja MA, Ranginwala M, Bazarbashi S: Pathologic response to paclitaxel-cisplatin versus 5-flurouracil, doxorubicin, cyclophosphamide primary therapy in locally advanced breast cancer. Am Soc Clinc Oncol Proc 34: 513 (abstract), 1998

    Google Scholar 

  38. Kuerer HM, Newman LA, Buzdar AU et al: Residual metastatic axillary lymph nodes following neoadjuvant chemotherapy predict disease-free survival in patients with locally advanced breast cancer. Am J Surg 176: 502–509, 1998

    Google Scholar 

  39. Ellis P, Smith I, Walsh S, Ebbs S, Baum M, Sacks N et al.: Clinical prognostic and predictive factors for primary chemotherapy in operable breast cancer. J Clin Oncol 16: 107–114, 1998

    Google Scholar 

  40. Makris A, Powles TJ, Ashly SE, Hickish T, Tidy VA, Nash AG et al.: A reduction in the requirements for mastectomy in a randomized trial of neoadjuvant chemoendocrine therapy in primary breast cancer. Ann Oncol 11: 1179–1184, 1998

    Google Scholar 

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Authors
  1. Adnan A. Ezzat
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  2. Ezzeldin M. Ibrahim
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  3. Dahish S. Ajarim
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  4. Mohammed M. Rahal
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  5. Madras A. Raja
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  6. Robert K. Stuart
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  7. Asma M. Tulbah
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  8. Alaa Kandil
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  9. Osama A. Al-Malik
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  10. Shouki M. Bazarbashi
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Ezzat, A.A., Ibrahim, E.M., Ajarim, D.S. et al. High complete pathological response in locally advanced breast cancer using paclitaxel and cisplatin. Breast Cancer Res Treat 62, 237–244 (2000). https://doi.org/10.1023/A:1006434406989

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