Anthracycline-based induction chemotherapy followed by concurrent cyclophosphamide, methotrexate and 5-fluorouracil and radiation therapy in surgically resected axillary node-positive breast cancer.
The present study aimed to determine the toxicity and efficacy of 4 courses of anthracyclines-taxane (AT) chemotherapy followed by radiation therapy (XRT) concurrent with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) in surgically resected axillary node-positive (N+) breast cancer. A total of 200 women with N+ breast cancer were treated with adriamycin and docetaxel followed by XRT concurrent with six courses of CMF. Two courses of dose-dense chemotherapy with ifosfamide, carboplatin and etoposide, supported by pegfilgrastim, were administered to patients with >5 histologically confirmed axillary lymph node metastases and patients with triple-negative disease. Additional treatments included 1 year of trastuzumab in human epidermal growth factor receptor 2-positive patients, 5 years of a luteinizing hormone-releasing hormone analogue in premenopausal women and 5 years of an aromatase inhibitor (AI) in estrogen receptor-positive (ER+) patients. The mean number of positive axillary lymph nodes was 4.4 (range, 2-37), 52% of the patients were premenopausal, 74% were ER+ and 26% had triple-negative disease. After a median follow-up of 73 months, grade 2 and 3 hematological toxicity was observed in 20% of the patients. The 10-year disease-free survival (DFS) and overall survival (OS) rates were 73 and 77%, respectively. There was no significant difference in DFS between ER+ and estrogen receptor-negative (ER-) patients (P>0.05), whereas the OS was better in ER+ vs. ER- patients (P<0.05) and in premenopausal vs. postmenopausal patients (P<0.005). In conclusion, induction AT concurrent CMF and XRT and dose-dense chemotherapy followed by AI in N+ high-risk breast cancer was associated with a low level of systemic and late cardiac toxicity and excellent local control, DFS and OS.
Department of Medical Oncology, Civilian Hospital, 67051 Avezzano, L'Aquila, Italy ; ; Carlo Ferri Foundation, 00013 Monterotondo, Rome; University of L'Aquila, 67100 L'Aquila, L'Aquila, Italy.
Francesco
F
Recchia
Department of Medical Oncology, Civilian Hospital, 67051 Avezzano, L'Aquila, Italy ;
Giampiero
G
Candeloro
Department of Medical Oncology, Civilian Hospital, 67051 Avezzano, L'Aquila, Italy ;
Alisia
A
Cesta
Laboratory of Radiobiology and Division of Radiotherapy, Department of Applied Clinical and Biotechnological Sciences; University of L'Aquila, 67100 L'Aquila, L'Aquila, Italy.
Mario
M
DI Staso
Laboratory of Radiobiology and Division of Radiotherapy, Department of Applied Clinical and Biotechnological Sciences; University of L'Aquila, 67100 L'Aquila, L'Aquila, Italy.
Pierluigi
P
Bonfili
Laboratory of Radiobiology and Division of Radiotherapy, Department of Applied Clinical and Biotechnological Sciences; University of L'Aquila, 67100 L'Aquila, L'Aquila, Italy.
Giovanni Luca
GL
Gravina
Laboratory of Radiobiology and Division of Radiotherapy, Department of Applied Clinical and Biotechnological Sciences; University of L'Aquila, 67100 L'Aquila, L'Aquila, Italy.
Ernesto
E
DI Cesare
Departments of Clinical Epidemiology, University of L'Aquila, 67100 L'Aquila, L'Aquila, Italy.
Stefano
S
Necozione
Surgical Oncology, University of L'Aquila, 67100 L'Aquila, L'Aquila, Italy.
Silvio
S
Rea
chemotherapy; node-positive breast cancer; radiation therapy; surgery