Malhotra V, Dorr VJ, Lyss AP, Anderson CM, Westgate S, Reynolds M, Barrett B,
Perry MC.
Division of Hematology/Medical Oncology, Ellis Fischel Cancer Center, University
of Missouri, Columbia, MO 65203, USA. malhotrav@earthlink.net
Fifty patients with histologically confirmed stage III breast cancer were
enrolled in this study of doxorubicin 50 mg/m2 and docetaxel 75 mg/m2
intravenously infused over 1 hour every 21 days with granulocyte
colony-stimulating factor for 4 cycles. This was followed by surgery (mastectomy
or lumpectomy) and 4 more cycles of doxorubicin/docetaxel postoperatively, then
radiation and tamoxifen as indicated. Forty-six of the 50 patients (92%)
completed neoadjuvant chemotherapy, and 38 patients (76%) completed adjuvant
chemotherapy. Clinical response (defined as > 50% decrease in size of tumor) was
achieved after 2 cycles in 37 patients (74%) and after 4 cycles in 42 of the 46
patients (91%) who finished neoadjuvant chemotherapy. Pathologic complete
response (pCR; no pathologic invasive cancer) at the primary site was obtained
in 7 of 46 patients (15%); 11 had no residual gross disease but did have
microscopic persistence or microscopic complete response (mCR), for a combined
pCR and mCR of 18 of 46 patients (39%). No treatment-related deaths occurred,
but 3 patients died during treatment: 1 from progressive disease, 1 from a
gastrointestinal bleeding, and 1 from unexplained sudden cardiac death.
Dose-limiting toxicities were hematologic (grade 3 neutropenia in 5 patients and
grade 4 in 23 patients). Congestive heart failure developed in 4 of 50 patients
(8%), with a mean decrease in left ventricular ejection fraction (LVEF) of 20%
in affected patients and 1 asymptomatic decrease in LVEF of 25%. At last
follow-up, 10 patients had died of progressive disease, and 1 each from sudden
cardiac death and lower gastrointestinal bleeding. In locally advanced breast
cancer, neoadjuvant doxorubicin/docetaxel is a very active regimen that achieved
pCR of 15% and a combined pCR and mCR of 39%, for an overall clinical response
rate of 91%. Adjuvant chemotherapy was complicated by dropouts and congestive
heart failure. This regimen should be used with close monitoring of cardiac
function.
Source :
http://www.docguide.com/news/content.nsf/PaperFrameSet?OpenForm&newsid=8525697700573E1885256F66003230DD&topabstract=1&u=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=15585077
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