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Neoadjuvant dose-dense gemcitabine plus docetaxel and vinorelbine plus epirubicin for operable breast cancer: improved prognosis in triple-negative tumors.

Medioni J, Huchon C, Le Frere-Belda MA, Hofmann H, Bats AS, Eme D, Andrieu JM, Oudard S, Lecuru F, Levy E - Drugs R D (2011)

Bottom Line: Among those without a pCR, RFS rates for patients with TNBC were significantly lower than for patients without TNBC (p = 0.04).Administering four drugs in a dose-dense alternating sequence gave a high pCR in patients with operable, invasive breast cancer.Patients with TNBC with a pCR had similar OS to patients without TNBC, whereas patients with TNBC without a pCR had poorer survival rate than their non-TNBC counterparts.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France. jacques.medioni@egp.aphp.fr

ABSTRACT

Background: Neoadjuvant anti-tumor activity of an alternating taxane- and anthracycline-based dose-dense regimen in patients with operable, non-inflammatory large breast cancer was investigated.

Objective: The objective is to study the rate of pathological complete response in patients with breast cancer receiving dose-dense chemotherapy sequentially with gemcitabine plus docetaxel and vinorelbine plus epirubicin.

Methods: Women (n = 74) with clinical stage II or III breast cancer were enrolled in this open-label, multicenter study to receive six 2-weekly courses of gemcitabine 1000 mg/m2 plus docetaxel 75 mg/m2 on days 1 and 15, and vinorelbine 25 mg/m2 plus epirubicin 100 mg/m2 on days 29 and 43. Patients with an objective response on day 56 then received another cycle of gemcitabine/docetaxel on day 57 and of vinorelbine/epirubicin on day 71. Conservative surgery was scheduled for all patients.

Results: Of the patients enrolled, 30% had triple-negative breast cancer (TNBC). The pathologic complete response (pCR) rate was 22% overall, but was higher in TNBC than patients without TNBC (40.9% vs 14.0%; p = 0.028). Among patients with a pCR, patients with TNBC had similar recurrence-free survival (RFS) and overall survival (OS) to patients without TNBC. Among those without a pCR, RFS rates for patients with TNBC were significantly lower than for patients without TNBC (p = 0.04). The most common severe hematologic toxicity was neutropenia.

Conclusions: Administering four drugs in a dose-dense alternating sequence gave a high pCR in patients with operable, invasive breast cancer. Patients with TNBC with a pCR had similar OS to patients without TNBC, whereas patients with TNBC without a pCR had poorer survival rate than their non-TNBC counterparts.

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Related in: MedlinePlus

Recurrence-free survival in patients with breast cancer without a pathologic complete response after neoadjuvant treatment with gemcitabine plus docetaxel alternating with vinorelbine plus epirubicin according to triple-negative status. HR = hazard ratio; TNBC = triple-negative breast cancer.
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Fig2: Recurrence-free survival in patients with breast cancer without a pathologic complete response after neoadjuvant treatment with gemcitabine plus docetaxel alternating with vinorelbine plus epirubicin according to triple-negative status. HR = hazard ratio; TNBC = triple-negative breast cancer.

Mentions: In patients with TNBC achieving a pCR, OS was similar to that of patients without TNBC with a pCR (5-year estimates of OS = 100% for both). Among patients without a pCR, ] was a trend towards lower OS in patients with TNBC than non-TNBC (3- and 5-year OS estimates were 84% and 42% for TNBC, and 97% and 82% for non-TNBC; p = 0.07) but the difference was not significant. Similarly, among patients with a pCR, the RFS of patients with TNBC was no different from that in patients with non-TNBC (3- and 5-year RFS estimates were 100% and 75% for TNBC and, 100% and 67% for non-TNBC; HR 0.6; 95% CI 0.03, 8.8; Log rank test: p = 0.66). Notably, however, of those patients without a pCR, RFS rates were significantly lower in patients with TNBC than those with non-TNBC (3- and 5-year RFS estimates were 62% and 62% for TNBC, and 89% and 79% for non-TNBC; HR 3.3; 95% CI 0.99, 10.8; Log rank test: p = 0.04).[figure 2].


Neoadjuvant dose-dense gemcitabine plus docetaxel and vinorelbine plus epirubicin for operable breast cancer: improved prognosis in triple-negative tumors.

Medioni J, Huchon C, Le Frere-Belda MA, Hofmann H, Bats AS, Eme D, Andrieu JM, Oudard S, Lecuru F, Levy E - Drugs R D (2011)

Recurrence-free survival in patients with breast cancer without a pathologic complete response after neoadjuvant treatment with gemcitabine plus docetaxel alternating with vinorelbine plus epirubicin according to triple-negative status. HR = hazard ratio; TNBC = triple-negative breast cancer.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3585987&req=5

Fig2: Recurrence-free survival in patients with breast cancer without a pathologic complete response after neoadjuvant treatment with gemcitabine plus docetaxel alternating with vinorelbine plus epirubicin according to triple-negative status. HR = hazard ratio; TNBC = triple-negative breast cancer.
Mentions: In patients with TNBC achieving a pCR, OS was similar to that of patients without TNBC with a pCR (5-year estimates of OS = 100% for both). Among patients without a pCR, ] was a trend towards lower OS in patients with TNBC than non-TNBC (3- and 5-year OS estimates were 84% and 42% for TNBC, and 97% and 82% for non-TNBC; p = 0.07) but the difference was not significant. Similarly, among patients with a pCR, the RFS of patients with TNBC was no different from that in patients with non-TNBC (3- and 5-year RFS estimates were 100% and 75% for TNBC and, 100% and 67% for non-TNBC; HR 0.6; 95% CI 0.03, 8.8; Log rank test: p = 0.66). Notably, however, of those patients without a pCR, RFS rates were significantly lower in patients with TNBC than those with non-TNBC (3- and 5-year RFS estimates were 62% and 62% for TNBC, and 89% and 79% for non-TNBC; HR 3.3; 95% CI 0.99, 10.8; Log rank test: p = 0.04).[figure 2].

Bottom Line: Among those without a pCR, RFS rates for patients with TNBC were significantly lower than for patients without TNBC (p = 0.04).Administering four drugs in a dose-dense alternating sequence gave a high pCR in patients with operable, invasive breast cancer.Patients with TNBC with a pCR had similar OS to patients without TNBC, whereas patients with TNBC without a pCR had poorer survival rate than their non-TNBC counterparts.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France. jacques.medioni@egp.aphp.fr

ABSTRACT

Background: Neoadjuvant anti-tumor activity of an alternating taxane- and anthracycline-based dose-dense regimen in patients with operable, non-inflammatory large breast cancer was investigated.

Objective: The objective is to study the rate of pathological complete response in patients with breast cancer receiving dose-dense chemotherapy sequentially with gemcitabine plus docetaxel and vinorelbine plus epirubicin.

Methods: Women (n = 74) with clinical stage II or III breast cancer were enrolled in this open-label, multicenter study to receive six 2-weekly courses of gemcitabine 1000 mg/m2 plus docetaxel 75 mg/m2 on days 1 and 15, and vinorelbine 25 mg/m2 plus epirubicin 100 mg/m2 on days 29 and 43. Patients with an objective response on day 56 then received another cycle of gemcitabine/docetaxel on day 57 and of vinorelbine/epirubicin on day 71. Conservative surgery was scheduled for all patients.

Results: Of the patients enrolled, 30% had triple-negative breast cancer (TNBC). The pathologic complete response (pCR) rate was 22% overall, but was higher in TNBC than patients without TNBC (40.9% vs 14.0%; p = 0.028). Among patients with a pCR, patients with TNBC had similar recurrence-free survival (RFS) and overall survival (OS) to patients without TNBC. Among those without a pCR, RFS rates for patients with TNBC were significantly lower than for patients without TNBC (p = 0.04). The most common severe hematologic toxicity was neutropenia.

Conclusions: Administering four drugs in a dose-dense alternating sequence gave a high pCR in patients with operable, invasive breast cancer. Patients with TNBC with a pCR had similar OS to patients without TNBC, whereas patients with TNBC without a pCR had poorer survival rate than their non-TNBC counterparts.

Show MeSH
Related in: MedlinePlus