Preoperative second-line chemotherapy induces objective responses in primary breast cancer.
OBJECTIVE
Preoperative chemotherapy in patients with primary breast cancer results in high response rates, allowing breast-conserving surgery in patients primarily not suitable for this procedure. Tumors of patients with histologically proven breast cancer that fail to respond to preoperative chemotherapy are thought to be chemotherapy resistant. We questioned this hypothesis and treated 13 patients who did not respond to preoperative anthracycline-containing first-line treatment.


METHODS
Eight patients received a combination therapy consisting of epidoxorubicin and docetaxel as neoadjuvant first-line treatment and were treated with CMF as preoperative second-line chemotherapy. The other five patients did not respond to first-line FEC and were given paclitaxel or docetaxel as second-line treatment.


RESULTS
A major response to treatment was observed in 10 of 13 patients (77%) during preoperative second-line therapy: one patient (8%) achieved pathological complete response (pCR) and nine patients (69%) partial response (PR). Three patients (23%) had stable disease (SD), and no patient had progressive disease (PD). Eight patients (62%) could undergo breast-conserving surgery.


CONCLUSIONS
We conclude that it is possible to achieve objective responses including pCR with potentially non-cross-resistant neoadjuvant second-line therapy, leading to breast-conserving surgery in a high proportion of patients. Thus, preoperative second-line chemotherapy appears to be justified when breast conservation is an important treatment goal and may have potential in improved tailoring of neoadjuvant treatments.
Division of Oncology, Department of Internal Medicine I, University Hospital of Vienna, Austria.
Catharina
C
Wenzel
Gottfried J
GJ
Locker
Rupert
R
Bartsch
Ursula
U
Pluschnig
Dagmar
D
Hussian
Christoph C
CC
Zielinski
Margarethe
M
Rudas
Michael F
MF
Gnant
Raimund
R
Jakesz
Guenther G
GG
Steger
D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D017239:Paclitaxel / Q000008:administration & dosage; D011300:Preoperative Care / Q000379:methods*; D043823:Taxoids / Q000008:administration & dosage; D017211:Treatment Failure; D016896:Treatment Outcome
D018943:Anthracyclines; D043823:Taxoids; D000077143:Docetaxel; D015251:Epirubicin; D003520:Cyclophosphamide; D017239:Paclitaxel; D002945:Cisplatin; D005472:Fluorouracil; D008727:Methotrexate