Neoadjuvant Chemotherapy in Breast Cancer: Significantly Enhanced Response With Docetaxel

Author:

Smith Ian C.1,Heys Steven D.1,Hutcheon Andrew W.1,Miller Iain D.1,Payne Simon1,Gilbert Fiona J.1,Ah-See Antoinne K.1,Eremin Oleg1,Walker Leslie G.1,Sarkar Tarun K.1,Eggleton S. Peter1,Ogston Keith N.1

Affiliation:

1. From the Departments of Academic Radiology and Surgery, University of Aberdeen, Aberdeen; Departments of Oncology and Pathology, Grampian University Hospitals National Health Service Trust, Aberdeen, Grampian, Scotland; Department of Surgery, Lincoln and Louth National Health Service Trust, Lincoln; Department of Rehabilitation Medicine, University of Hull, Hull, England; and Aventis Pharma, West Malling, Kent, United Kingdom.

Abstract

PURPOSE: To compare the efficacy of neoadjuvant (NA) docetaxel (DOC) with anthracycline-based therapy and determine the efficacy of NA DOC in patients with breast cancer initially failing to respond to anthracycline-based NA chemotherapy (CT). PATIENTS AND METHODS: Patients with large or locally advanced breast cancer received four pulses of cyclophosphamide 1,000 mg/m2, doxorubicin 50 mg/m2, vincristine 1.5 mg/m2, and prednisolone 40 mg (4 × CVAP) for 5 days. Clinical tumor response was assessed. Those who responded (complete response [CR] or partial response [PR]) were randomized to receive further 4 × CVAP or 4 × DOC (100 mg/m2). All nonresponders received 4 × DOC. RESULTS: One hundred sixty-two patients were enrolled; 145 patients completed eight cycles of NA CT. One hundred two patients (66%) achieved a clinical response (PR or CR) after 4 × CVAP. After randomization, 50 patients received 4 × CVAP and 47 patients received 4 × DOC. In patients who received eight cycles of CT, the clinical CR (cCR) and clinical PR (cPR) (94% v 66%) and pathologic CR (pCR) (34% v 16%) response rates were higher (P = .001 and P = .04) in those who received further DOC. Intention-to-treat analysis demonstrated cCR and cPR (85% v 64%; P = .03) and pCR (31% v 15%; P = .06). Axillary lymph node examination revealed residual tumor in 33% of patients who received 8 × CVAP and 38% of patients who received further DOC. In patients who failed to respond to the initial CVAP, 4 × DOC resulted in a cCR and cPR rate of 55% and a pCR rate of 2%. Forty-four percent of these patients had residual tumor within axillary lymph nodes. CONCLUSION: NA DOC resulted in substantial improvement in responses to DOC.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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