title: Adjuvant Ovarian Suppression, High-dose Chemotherapy and Immunotherapy for Premenopausal Patients with High-risk Breast Cancer.
abstract: BACKGROUND
  Premenopausal patients with breast cancer and more than 10 positive axillary nodes (BC>10) have a poor prognosis: In these patients the best adjuvant therapy (CT) has not yet been established.
  
  
  METHODS
  Forty-two BC>10 received, in sequence, the following adjuvant treatments: luteinizing hormone releasing hormone (LH-RH) analog for 5 years; anthracycline-based induction chemotherapy; radiation therapy; platinum-based high-dose CT, with autologous bone marrow transplantation; immunotherapy with interleukin 2 (IL2) and 13-cis retinoic acid (RA); anastrazole given 5 years to estrogen receptor-positive patients. Primary endpoints of the study were disease-free survival (DFS) and overall (OS) survival. A secondary endpoint was toxicity.
  
  
  RESULTS
  The median age of patients was 41 years, and the mean number of positive axillary nodes was 14. Estrogen and progesterone receptors were positive in 57% and 29% of patients respectively, while 14% of patients had triple-negative disease. With a median follow-up of 120 months for patients remaining alive at the end of study, median DFS and OS, had not yet been reached. The 20-year DFS and OS rates were 63.8%, and 81.6%, respectively. One to two years after the end of the therapy, three patients had had four full-term pregnancies.
  
  
  CONCLUSIONS
  Treatment with LH-RH analog, high-dose CT, peripheral blood progenitor cells and IL2 with RA for patients with BC>10 is feasible, has moderate toxicity, while preserving ovarian function, seems to improve the expected DFS and OS for these high-risk patients.
authors.affiliation: Oncology Department, Civilian Hospital, Avezzano, Italy Carlo Ferri Foundation, Monterotondo, Rome, Italy frecchia1946@libero.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Recchia
authors.affiliation: Oncology Department, Civilian Hospital, Avezzano, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Candeloro
authors.affiliation: Oncology Department, Civilian Hospital, Frascati, Italy Carlo Ferri Foundation, Monterotondo, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Rosselli
authors.affiliation: Carlo Ferri Foundation, Monterotondo, Rome, Italy Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Aquila, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bratta
authors.affiliation: Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Pasta
authors.affiliation: Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: D'Orazi
authors.affiliation: Department of Surgical Sciences, Lecco Hospital, Lecco, Italy.
authors.forename: Luca A
authors.initials: LA
authors.lastname: Fumagalli
authors.affiliation: Carlo Ferri Foundation, Monterotondo, Rome, Italy Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Aquila, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Rea
mesh_terms: D000328:Adult; D000077384:Anastrozole; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D023381:Endpoint Determination; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007167:Immunotherapy; D007376:Interleukin-2 / Q000627:therapeutic use*; D015474:Isotretinoin / Q000627:therapeutic use*; D016729:Leuprolide / Q000627:therapeutic use*; D009570:Nitriles / Q000627:therapeutic use*; D017697:Premenopause; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D014230:Triazoles / Q000627:therapeutic use*; D064726:Triple Negative Breast Neoplasms / Q000378:metabolism
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D007376:Interleukin-2; D009570:Nitriles; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D014230:Triazoles; D000077384:Anastrozole; D005047:Etoposide; D016190:Carboplatin; D016729:Leuprolide; D015474:Isotretinoin; D007069:Ifosfamide
keywords: Adjuvant ovarian suppresion; breast cancer; immunotherapy; premenopausal