title: Inclusion of taxanes, particularly weekly paclitaxel, in preoperative chemotherapy improves pathologic complete response rate in estrogen receptor-positive breast cancers.
abstract: BACKGROUND
  We examined if inclusion of a taxane and more prolonged preoperative chemotherapy improves pathologic complete response (pCR) rate in estrogen receptor (ER)-positive breast cancer compared with three to four courses of 5-fluorouracil, doxorubicin, cyclophosphamide (FAC).
  
  
  METHODS
  Pooled analysis of results from seven consecutive neo-adjuvant chemotherapy trials including 1079 patients was carried out. These studies were conducted at MD Anderson Cancer Center from 1974 to 2001. Four hundred and twenty-six (39.5%) patients received taxane-based neo-adjuvant therapy. pCR rates and survival times were analyzed as a function of chemotherapy regimen and ER status. Multivariate logistic and Cox regression analysis were carried out to identify variables associated with pCR and survival.
  
  
  RESULTS
  Patients with ER-negative cancer had higher overall pCR rate than patients with ER-positive tumors (20.1% versus 4.9%, P < 0.001). In ER-negative patients, the pCR rates were 29% and 15% with and without a taxane (P < 0.001). In ER-positive patients, the pCR rates were 8.8% and 2.0% with and without a taxane (P < 0.001). In multivariate analysis, clinical tumor size (P < 0.001), ER-negative status (P < 0.001) and inclusion of a taxane (P = 0.01) were independently associated with pCR. For patients with pCR, survival was similar regardless of ER status or the type of regimen that induced pCR.
  
  
  CONCLUSIONS
  pCR rates increased for patients with both ER-positive and ER-negative tumors as regimens started to include a taxane and became longer. This indicates that a subset of patients with ER-positive breast cancer benefits from more aggressive chemotherapy, similarly to patients with ER-negative tumors.
authors.affiliation: Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA.
authors.forename: C
authors.initials: C
authors.lastname: Mazouni
authors.forename: S-W
authors.initials: SW
authors.lastname: Kau
authors.forename: D
authors.initials: D
authors.lastname: Frye
authors.forename: F
authors.initials: F
authors.lastname: Andre
authors.forename: H M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: T A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: W F
authors.initials: WF
authors.lastname: Symmans
authors.forename: K
authors.initials: K
authors.lastname: Anderson
authors.forename: K R
authors.initials: KR
authors.lastname: Hess
authors.forename: A M
authors.initials: AM
authors.lastname: Gonzalez-Angulo
authors.forename: G N
authors.initials: GN
authors.lastname: Hortobagyi
authors.forename: A U
authors.initials: AU
authors.lastname: Buzdar
authors.forename: L
authors.initials: L
authors.lastname: Pusztai
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000145:classification / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology; D001952:Bridged-Ring Compounds; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy* / Q000601:surgery; D017239:Paclitaxel / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D011379:Prognosis; D011960:Receptors, Estrogen / Q000378:metabolism*; D016019:Survival Analysis; D043823:Taxoids; D047368:Tumor Burden / Q000187:drug effects
chemical_list: D001952:Bridged-Ring Compounds; D011960:Receptors, Estrogen; D043823:Taxoids; C080625:taxane; D004317:Doxorubicin; D003520:Cyclophosphamide; D017239:Paclitaxel; D005472:Fluorouracil