Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel.
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.
Smith
Ian C
IC
Department of Academic Radiology, University of Aberdeen, Foresterhill, Aberdeen, Scotland, United Kingdom. i.c.smith@abdn.ac.uk
Heys
Steven D
SD
Hutcheon
Andrew W
AW
Miller
Iain D
ID
Payne
Simon
S
Gilbert
Fiona J
FJ
Ah-See
Antoinne K
AK
Eremin
Oleg
O
Walker
Leslie G
LG
Sarkar
Tarun K
TK
Eggleton
S Peter
SP
Ogston
Keith N
KN
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*
D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D000077143:Docetaxel; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D017239:Paclitaxel