title: Efficacy, toxicity, and applicability of high-dose sequential chemotherapy as adjuvant treatment in operable breast cancer with 10 or more involved axillary nodes: five-year results.
abstract: OBJECTIVE
  To assess the efficacy, toxicity, and applicability of high-dose therapy administered as adjuvant initial treatment to women with breast cancer with extensive nodal involvement.
  
  
  METHODS
  Sixty-seven patients with stage II to III breast cancer involving > or = 10 axillary nodes received a novel high-dose sequential (HDS) regimen, including the high-dose administration of three non-cross-resistant drugs (cyclophosphamide, methotrexate, and melphalan) given within the shortest interval of time as possible with hematologic and nonhematologic toxicity.
  
  
  RESULTS
  Sixty-three patients completed the program as planned, one patient died of acute toxicity, and three patients were switched to standard-dose adjuvant therapy. After a median follow-up duration of 48.5 months and a lead follow-up of 78 months, actuarial relapse-free survival for all 67 registered patients is 57% and overall survival is 70%, respectively. Comparison with a historical control group of 58 consecutive patients showed a significantly superior rate of freedom from relapse for the HDS-treated group (57% v 41%, respectively), in particular when two subgroups of patients, more homogeneous for their number of involved nodes, were compared (65% v 42%). Overall, treatment was of short duration (median, 70 days), required a median of 32 days of hospital stay, and was associated with only a few severe side effects (the most distressing being oral mucositis after melphalan therapy).
  
  
  CONCLUSIONS
  HDS therapy emerges as an effective and applicable regimen, whose major toxicity was occasional. Final assessment of its value in a randomized, multicenter trial is presently underway.
authors.affiliation: Department of Medical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Gianni
authors.forename: S
authors.initials: S
authors.lastname: Siena
authors.forename: M
authors.initials: M
authors.lastname: Bregni
authors.forename: M
authors.initials: M
authors.lastname: Di Nicola
authors.forename: S
authors.initials: S
authors.lastname: Orefice
authors.forename: F
authors.initials: F
authors.lastname: Cusumano
authors.forename: B
authors.initials: B
authors.lastname: Salvadori
authors.forename: A
authors.initials: A
authors.lastname: Luini
authors.forename: M
authors.initials: M
authors.lastname: Greco
authors.forename: R
authors.initials: R
authors.lastname: Zucali
authors.forename: F
authors.initials: F
authors.lastname: Rilke
authors.forename: M
authors.initials: M
authors.lastname: Zambetti
authors.forename: P
authors.initials: P
authors.lastname: Valagussa
authors.forename: G
authors.initials: G
authors.lastname: Bonadonna
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D008198:Lymph Nodes / Q000187:drug effects / Q000473:pathology*; D008408:Mastectomy; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged
chemical_list: D004317:Doxorubicin; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003520:Cyclophosphamide; D008558:Melphalan; D008727:Methotrexate