title: Combined sequential approach in locally advanced breast cancer.
abstract: BACKGROUND
  The interaction between primary and adjuvant chemotherapy is a crucial point in the treatment of locally advanced breast cancer.
  
  
  OBJECTIVE
  To evaluate the therapeutic efficacy of a sequential treatment with primary anthracyclines and adjuvant CMF in this patient subset.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Eighty-eight breast cancer patients, stage T3b-T4 abc, N0-2, M0.
  
  
  RESULTS
  From February 1991 to July 1994, 88 consecutive patients with locally advanced breast cancer were treated at the Istituto Nazionale Tumori, Milano, with full-dose doxorubicin (75 mg/m2) or epirubicin (120 mg/m2) for three cycles followed by surgery, adjuvant chemotherapy with i.v. CMF for six cycles and local radiotherapy +/- Tamoxifen. A high rate of objective responses (70%), but a low incidence of pathologic complete remission (2%), were observed following primary treatment with single-agent anthracyclines. Frequency of responses was not associated with tumor estrogen or progesterone receptors status, Mib-1 or grading. In 28 patients (32%) conservative surgery could be performed. At a median follow-up of 52 months, relapse free survival and overall survival are 52% and 62%, respectively. A multivariate analysis demonstrated a significant favorable prognosis in patients with limited nodal involvement at surgery and negative Mib-1 values. This drug sequence failed to significantly ameliorate the long term results in this unfavorable patient subset and more effective drug regimens and innovative therapeutic strategies are needed.
authors.affiliation: Istituto Nazionale Tumori, Milano, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Zambetti
authors.forename: S
authors.initials: S
authors.lastname: Oriana
authors.forename: P
authors.initials: P
authors.lastname: Quattrone
authors.forename: P
authors.initials: P
authors.lastname: Verderio
authors.forename: M
authors.initials: M
authors.lastname: Terenziani
authors.forename: R
authors.initials: R
authors.lastname: Zucali
authors.forename: P
authors.initials: P
authors.lastname: Valagussa
authors.forename: G
authors.initials: G
authors.lastname: Bonadonna
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D018931:Antineoplastic Agents, Hormonal; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015413:Mastectomy, Simple; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D013629:Tamoxifen / Q000008:administration & dosage
chemical_list: D000903:Antibiotics, Antineoplastic; D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen; D015251:Epirubicin; D004317:Doxorubicin