title: Feasibility study of FEC-chemotherapy with dose-intensive epirubicin as initial treatment in high-risk breast cancer.
abstract: BACKGROUND
  The prognosis of patients with stage III B breast carcinoma with metastasis to the apical axillary lymph nodes is poor despite adequate local control achieved by surgery and/or radiation therapy. This study evaluated the feasibility of a dose-intensive up-front chemotherapy regimen in this subgroup of patients.
  
  
  METHODS
  A preoperative chemotherapy regimen consisting of 3 courses of fluorouracil 500 mg/m2, dose-intensive epidoxorubicin 120 mg/m2 and cyclophosphamide 500 mg/m2 (DIE-FEC), was administered at 21-day intervals without hematopoietic growth factors to 31 patients with apex-positive disease. All patients were below 60 years of age and none had had prior chemotherapy or radiotherapy.
  
  
  RESULTS
  Seven patients achieved clinical complete responses (23%), and 21 achieved clinical partial responses (68%); three patients had stable disease (10%), one of whom had only ductal carcinoma in situ at histopathologic evaluation, which suggested an additional response to therapy. The major toxicity was moderate bone marrow suppression with a median WBC nadir of 1650/microliters (range 500-4600). Other toxic effects were mild.
  
  
  CONCLUSIONS
  DIE-FEC is well-tolerated and highly effective as up-front chemotherapy in relatively young patients with high-risk breast cancer, with a 90% (CI 74%-98%) clinical objective response rate.
authors.affiliation: Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam.
authors.forename: E
authors.initials: E
authors.lastname: van der Wall
authors.forename: D J
authors.initials: DJ
authors.lastname: Richel
authors.forename: Y H
authors.initials: YH
authors.lastname: Kusumanto
authors.forename: E J
authors.initials: EJ
authors.lastname: Rutgers
authors.forename: J H
authors.initials: JH
authors.lastname: Schornagel
authors.forename: C C
authors.initials: CC
authors.lastname: Schaake-Koning
authors.forename: J L
authors.initials: JL
authors.lastname: Peterse
authors.forename: S
authors.initials: S
authors.lastname: Rodenhuis
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage / Q000627:therapeutic use*; D004906:Erythrocyte Count; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D010976:Platelet Count
chemical_list: D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil