title: Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Patients with large or locally advanced breast cancer received four pulses of cyclophosphamide 1,000 mg/m(2), doxorubicin 50 mg/m(2), vincristine 1.5 mg/m(2), and prednisolone 40 mg (4 x 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 x CVAP or 4 x DOC (100 mg/m(2)). All nonresponders received 4 x 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 x CVAP. After randomization, 50 patients received 4 x CVAP and 47 patients received 4 x 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 x CVAP and 38% of patients who received further DOC. In patients who failed to respond to the initial CVAP, 4 x 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.
  
  
  CONCLUSIONS
  NA DOC resulted in substantial improvement in responses to DOC.
authors.affiliation: Department of Academic Radiology, University of Aberdeen, Foresterhill, Aberdeen, Scotland, United Kingdom. i.c.smith@abdn.ac.uk
authors.forename: Ian C
authors.initials: IC
authors.lastname: Smith
authors.forename: Steven D
authors.initials: SD
authors.lastname: Heys
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Hutcheon
authors.forename: Iain D
authors.initials: ID
authors.lastname: Miller
authors.forename: Simon
authors.initials: S
authors.lastname: Payne
authors.forename: Fiona J
authors.initials: FJ
authors.lastname: Gilbert
authors.forename: Antoinne K
authors.initials: AK
authors.lastname: Ah-See
authors.forename: Oleg
authors.initials: O
authors.lastname: Eremin
authors.forename: Leslie G
authors.initials: LG
authors.lastname: Walker
authors.forename: Tarun K
authors.initials: TK
authors.lastname: Sarkar
authors.forename: S Peter
authors.initials: SP
authors.lastname: Eggleton
authors.forename: Keith N
authors.initials: KN
authors.lastname: Ogston
mesh_terms: D000328:Adult; D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016009:Chi-Square Distribution; D003520:Cyclophosphamide / Q000627:therapeutic use*; D000077143:Docetaxel; D004317:Doxorubicin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D017239:Paclitaxel / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D011239:Prednisolone / Q000627:therapeutic use*; D043823:Taxoids; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use*
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D000077143:Docetaxel; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D017239:Paclitaxel