Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel

I. C. Smith, Steven Darryll Heys, A. W. Hutcheon, Iain D Miller, S. Payne, Fiona Jane Gilbert, A. K. Ah-See, O. Eremin, L. G. Walker, T. K. Sarkar, S. P. Eggleton, Keith Nicholas Ogston

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Abstract

Purpose: To compare the efficacy of neoadjuvant (NA) docetaxel (DOC) with anthracycline-based therapy and determine the efficacy of NA DOC in patients with breast cancer initially failing to respond to anthracycline-based NA chemotherapy (CT).

Patients and Methods: Patients with large or locally advanced breast cancer received four pulses of cyclophosphamide 1,000 mg/m(2), doxorubicin 50 mg/m(2), vincristine 1.5 mg/m(2), and prednisolone 40 mg (4 x CVAP) for 5 days. Clinical tumor response was assessed. Those who responded (complete response [CR] or partial response [PR]) were randomized to receive further 4 x CVAP or 4 x DOC (100 mg/m(2)). All nonresponders received 4 x DOC.

Results: One hundred sixty-two patients were enrolled; 145 patients completed eight cycles of NA CT. One hundred two patients (66%) achieved a clinical response (PR or CR) after 4 x CVAP. After randomization, 50 patients received 4 x CVAP and 47 patients received 4 x DOC. In patients who received eight cycles of CT, the clinical CR (cCR) and clinical PR (cPR) (94% v 66%) and pathologic CR (pCR) (34% v 16%) response rates were higher (P=.001 and P=.04) in those who received further DOC. Intention-to-treat analysis demonstrated cCR and cPR (85% v 64%; P=.03) and pCR (31% v 15%; P=.06). Axillary lymph node examination revealed residual tumor in 33% of patients who received 8 x CVAP and 38% of patients who received further DOC. In patients who failed to respond to the initial CVAP, 4 x DOC resulted in a cCR and cPR rate of 55% and a pCR rate of 2%. Forty-four percent of these patients had residual tumor within axillary lymph nodes.

Conclusion: NA DOC resulted in substantial improvement in responses to DOC.

Original languageEnglish
Pages (from-to)1456-1466
Number of pages10
JournalJournal of Clinical Oncology
Volume20
Issue number6
DOIs
Publication statusPublished - Mar 2002

Keywords

  • AXILLARY LYMPH-NODES
  • PHASE-II TRIAL
  • PATHOLOGICAL RESPONSE
  • ANTHRACYCLINE-RESISTANT
  • INDUCTION CHEMOTHERAPY
  • MULTIDRUG-RESISTANCE
  • PRIMARY TUMOR
  • THERAPY
  • DOXORUBICIN
  • COMBINATION

Cite this

Smith, I. C., Heys, S. D., Hutcheon, A. W., Miller, I. D., Payne, S., Gilbert, F. J., Ah-See, A. K., Eremin, O., Walker, L. G., Sarkar, T. K., Eggleton, S. P., & Ogston, K. N. (2002). Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel. Journal of Clinical Oncology, 20(6), 1456-1466. https://doi.org/10.1200/JCO.20.6.1456