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01.09.2008 | Original Article

Tailored preoperative treatment of locally advanced triple negative (hormone receptor negative and HER2 negative) breast cancer with epirubicin, cisplatin, and infusional fluorouracil followed by weekly paclitaxel

verfasst von: Rosalba Torrisi, Alessandra Balduzzi, Raffaella Ghisini, Andrea Rocca, Luca Bottiglieri, Filippo Giovanardi, Paolo Veronesi, Alberto Luini, Laura Orlando, Giuseppe Viale, Aron Goldhirsch, Marco Colleoni

Erschienen in: Cancer Chemotherapy and Pharmacology | Ausgabe 4/2008

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Abstract

Background

No specific treatment guidelines are available for triple-negative breast cancers, defined by a lack of expression of estrogen (ER), progesterone (PgR), and HER2 receptors.

Patients and methods

We investigated in patients with T2–T3 N0-3 ER, PgR <10% and HER2 negative breast cancers the activity both in terms of pathological (pCR) and objective responses of four courses of cisplatin containing chemotherapy (ECF, epirubicin, cisplatin, and fluorouracil as continuous infusion) followed by three courses of weekly paclitaxel. Adjuvant metronomic chemotherapy including cyclophosphamide and methotrexate for 4–6 months was administered.

Results

Thirty patients are evaluable. Median age was 41 years (28–64 years). Twenty-three of 25 evaluable tumors stained positively for epidermal growth factor receptor. An objective response, either complete and partial, was observed in 26 patients (86, 95% CI 69.3–96.2%). and a pCR was obtained in 12 patients (40, 95% CI 22.7–59.4%). Two patients progressed during paclitaxel. Negative axillary nodes were found in 80% (95% CI 61.4–92.3%) of patients at surgery. Twenty-six patients (86, 95% CI 61.4–92.3%) underwent breast conserving surgery. Grade >2 non-hematological toxicity was observed in three and two patients during ECF and paclitaxel, respectively. The 2-year disease free survival (DFS) was 87.5% (95% CI 74.7–100%). No significant correlation was observed between EGFR staining and either pCR or DFS.

Conclusions

Preoperative cisplatin containing chemotherapy followed by paclitaxel induced an high pCR rate in a population of triple-negative breast cancer. The impact of this schedule on long-term outcome should be investigated in larger series.

Berry DA, Cirrincione C, Henderson IC, Citron ML, Budman MR, Goldstein LJ et al (2006) Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA 295:1658–1667PubMedCrossRef

Smith IC, Heys SD, Hutcheon AW, Miller ID, Payne S, Gilbert FJ et al (2002) Neoadjuvant chemotherapy in breast cancer: significant enhanced response with docetaxel. J Clin Oncol 20:1456–1466PubMedCrossRef

Bear HD, Anderson S, Brown A, Smith R, Mamounas EP, Fisher E et al (2003) The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from national surgical adjuvant breast and bowel project protocol B-27. J Clin Oncol 21:4165–4174PubMedCrossRef

Von Minckwitz G, Raab G, Caputo A, Schutte M, Hilfrich J, Blohmer JU et al (2005) Doxorubicin with cyclophosphamide followed by docetaxel every 21 days compared with doxorubicin and docetaxel every 14 days as preoperative treatment in operable breast cancer: the GEPARDUO study of the German Breast Group. J Clin Oncol 23:2676–2685CrossRef

Miller KD, McCaskill-Stevens W, Sisk J, Loesch DM, Monaco F, Sehsadri R et al (1999) Combination versus sequential doxorubicin and docetaxel as primary chemotherapy for breast cancer:a randomized pilot trial of the Hoosier Oncology Group. J Clin Oncol 17:3033–3037PubMed

Colleoni M, Viale G, Zahrieh D, Pruneri G, Gentilini O, Veronesi P et al (2004) Chemotherapy is more effective in patients with breast cancer not expressing steroid hormone receptors: a study of preoperative treatment. Clin Cancer Res 10:6622–6628PubMedCrossRef

Gianni L, Baselga J, Eiermann W, Guillem Porta V, Semiglazov V, Lluch A et al (2005) Feasibility and tolerability of sequential doxorubicin/paclitaxel followed by cyclophosphamide, methotrexate, and fluorouracil and its effects on tumor response as preoperative therapy. Clin Cancer Res 11:8715–8721PubMedCrossRef

Cleator S, Heller W, Coombes RC (2007) Triple-negative breast cancer: therapeutic options. Lancet Oncol 8:235–244PubMedCrossRef

Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H et al (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 98:10869–10874PubMedCrossRef

10.

Dent R, Trudeau M, Pritchard KI, Hanna WM, Kahn HK, Sawka CA et al (2007) Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res 13:4429–4434PubMedCrossRef

11.

Rouzier R, Perou CM, Symmans WF, Ibrahim N, Cristofanilli M, Anderson K et al (2005) Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res 11:5678–5685PubMedCrossRef

12.

Smith IE, A’Hern RP, Coombes GA, Howell A, Ebbs SR, Hickish TF et al (2004) A novel continuous infusional 5-fluorouracil-based chemotherapy regimen compared with conventional chemotherapy in the neo-adjuvant treatment of early breast cancer: 5 year results of the TOPIC trial. Ann Oncol 15:751–758PubMedCrossRef

13.

Green MC, Buzdar AU, Smith T, Ibrahim NK, Valero V, Rosales MF et al (2005) Weekly paclitaxel improves pathological complete remission in operable breast cancer when compared with paclitaxel one every 3 weeks. J Clin Oncol 23:5983–5992PubMedCrossRef

14.

Seidman AD, Berry D, Cirrincione C et al (2004) Phase III study of weekly (W) paclitaxel (P) via 1-hour (h) infusion versus standard (S) 3h infusion every third week in the treatment of metastatic breast cancer (MBC) with trastuzumab (T) for HER2 positive MBC and trandomized T in HER2 normal MBC. Proc Am Soc Clin Oncol 22:6s (Abstract 512)

15.

Therasse P, Arbuck SG, Eisenhauer EA, Wanders S, Kaplan J, Rubinstein L et al (2000) New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst 92:205–216PubMedCrossRef

16.

Kuerer HM, Newman LA, Smith TM, Ames FC, Hunt KK, Dhingra K et al (1999) Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol 17:460–469PubMed

17.

Simon R (1989) Optimal two-stage designs for phase II clinical trials. Control Clin Trials 10:1–10PubMedCrossRef

18.

Nielsen TO, Hsu FD, Jensen K, Cheang M, Karaca G, Hu Z et al (2004) Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma. Clin Cancer Res 10:5637–5374CrossRef

19.

Banerjee S, Reis-Filho JS, Ashley S, Steele D, Ashworth A, Lakhani SR et al (2006) Basal-like breast carcinomas: clinical outcome and response to chemotherapy. J Clin Pathol 59:729–735PubMedCrossRef

20.

Carey LA, Dees EC, Sawyer LR, Gatti L, Moore DT, Collichio F et al (2007) The triple negative paradox: primary tumor sensitivity breast cancer subtypes. Clin Cancer Res 13:2329–2334PubMedCrossRef

21.

James CR, Quinn JE, Mullan PB, Johnston PG, Harkin DP (2007) BRCA1, a potential predictive biomarker in the treatment of breast cancer. Oncologist 12:142–150PubMedCrossRef

22.

Frasci G, D’Aiuto G, Comella P, Thomas R, Botti G, Di Bonito M et al (2005) A 2-month cisplatin-epirubicin-paclitaxel (PET) weekly combination as primary systemic therapy for large operable breast cancer: a phase II study. Ann Oncol 16:1268–1275PubMedCrossRef

23.

Garber JE, Richardson A, Harris LN et al (2006) Neoadjuvant cisplatin (CDDP) in triple-negative breast cancer. Breast Cancer Res Treat Abstract 3074

24.

Rocca A, Peruzzotti G, Ghisini R, Viale G, Veronesi P, Luini A et al (2006) A randomized phase II trial comparing preoperative plus perioperative chemotherapy with preoperative chemotherapy in patients with locally advanced breast cancer. Anticancer Drugs 17:1201–1209PubMedCrossRef

25.

Andre F, Mazouni C, Liedtke C, Kau SW, Frye D, Green M et al (2007) HER2 expression and efficacy pf preoperative paclitaxel/FAC chemotherapy in breast cancer. Breast Cancer Res Treat. doi:10.1007/s10549-007-9594-8

26.

Bear HD, Anderson S, Smith RE, Geyer CE Jr, Mamounas EP, Fisher B et al (2006) Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: national surgical adjuvant breast and bowel project protocol B-27. J Clin Oncol 24:2019–2027PubMedCrossRef

27.

Hennessy BT, Hortobagyi GN, Rouzier R, Kuerer H, Sneige N, Buzdar AU et al (2005) Outcome after pathologic complete eradication of cytologically proven breast cancer axillary node metastases following primary chemotherapy. J Clin Oncol 23:9304–9311PubMedCrossRef

28.

Torrisi R, Orlando L, Ghisini R, Veronesi P, Intra M, Rocca A et al (2006) A phase II study of primary dose-dense sequential doxorubicin plus cyclophosphamide and docetaxel in cT4 breast cancer. Anticancer Res 25:2861–2864

29.

Livasy CA, Karaca G, Nanda R, Tretiakova MS, Olopade OI, Moore DT et al (2006) Phenotypic evaluation of the basal-like subtype of invasive breast carcinoma. Mod Pathol l19:264–271CrossRef

Titel: Tailored preoperative treatment of locally advanced triple negative (hormone receptor negative and HER2 negative) breast cancer with epirubicin, cisplatin, and infusional fluorouracil followed by weekly paclitaxel
verfasst von: Rosalba Torrisi
Alessandra Balduzzi
Raffaella Ghisini
Andrea Rocca
Luca Bottiglieri
Filippo Giovanardi
Paolo Veronesi
Alberto Luini
Laura Orlando
Giuseppe Viale
Aron Goldhirsch
Marco Colleoni
Publikationsdatum: 01.09.2008
Verlag: Springer-Verlag
Erschienen in: Cancer Chemotherapy and Pharmacology / Ausgabe 4/2008
Print ISSN: 0344-5704
Elektronische ISSN: 1432-0843
DOI: https://doi.org/10.1007/s00280-007-0652-z

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Tailored preoperative treatment of locally advanced triple negative (hormone receptor negative and HER2 negative) breast cancer with epirubicin, cisplatin, and infusional fluorouracil followed by weekly paclitaxel