High pathologic complete response in HER 2-positive locally advanced breast cancer after primary systemic chemotherapy with weekly docetaxel and epirubicin.
BACKGROUND
To evaluate pathological complete response rate and to identify the predictor of response after primary systemic chemotherapy (PST) with weekly docetaxel and epirubicin for locally advanced breast cancer.


METHODS
Sixty-three patients with locally advanced breast cancer received three cycles PST on day 1 and 8 of each 3-week cycle with epirubicin and docetaxel (epirubicin 45 mg/m(2) intravenous bolus, docetaxel 35 mg/m(2) in 100 ml normal saline infused 1 h), followed by surgery and adjuvant chemotherapy with cyclophosphamide, epirubicin and 5-fluorouracil. The pathological complete response was defined as no invasive carcinoma in breast and axillary nodes after PST.


RESULTS
The median tumor sizes (by ultrasound) before and after PST were 6.2 and 2.5 cm, respectively. The negative estrogen receptor (ER) by immunochemical stain was found in 33 (52.4%) patients and HER-2/neu-overexpression in 12 (19.0%) patients. Clinical overall response rate (ORR) was 89% (95% confidence intervals (95% CI: 81-97), including 38% complete response (95% CI: 26-50), sonographical ORR was 97% (95% CI: 93-100). The pathological complete response were found in 11 patients (18%, 95% CI: 9-27), and 15(24%, 95% CI: 13-35) patients achieved breast only pathological complete response. Nine (27.3%) of thirty-three ER (-) patients and 5 (41.7%) of 12 HER2-positive patients achieved pathological complete response.


CONCLUSIONS
PST with weekly docetaxel and epirubicin were well-tolerated and very high pathological complete response rate was achieved in HER-2/neu-overexpression tumors.
Chen
Shin-Cheh
SC
Department of Surgery, Chang-Gung Memorial Hospital, 199, Tung-Hwa North Road, Taipei, Taiwan. chensc@adm.cgmh.org.tw
Chang
Hsien-Kun
HK
Lin
Yung-Chang
YC
Hsueh
Swei
S
Cheung
Yun-Chung
YC
Leung
Wai-Man
WM
Tsai
Chien-Sheng
CS
Lo
Yung-Feng
YF
Tsai
Hsiu-Pei
HP
Shen
Shih-Che
SC
Chen
Miin-Fu
MF
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis*; D001943:Breast Neoplasms / Q000737:chemistry / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D000077143:Docetaxel; D004334:Drug Administration Schedule; D004562:Electrocardiography; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis*; D013318:Stroke Volume; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome; D016217:Ultrasonography, Mammary; D015854:Up-Regulation; D016277:Ventricular Function, Left
D000903:Antibiotics, Antineoplastic; D000972:Antineoplastic Agents, Phytogenic; D014408:Biomarkers, Tumor; D003520:Cyclophosphamide; D000077143:Docetaxel; D015251:Epirubicin; D005472:Fluorouracil; D018719:Erb-b2 Receptor Tyrosine Kinases; D043823:Taxoids