The potential risk of neoadjuvant chemotherapy in breast cancer patients - results from a prospective randomized trial of the Austrian Breast and Colorectal Cancer Study Group (ABCSG-07)

被引:46
作者
Taucher, Susanne [1 ]
Steger, Guenther G. [2 ]
Jakesz, Raimund [3 ]
Tausch, Christoph [4 ]
Wette, Viktor [5 ]
Schippinger, Walter [6 ]
Kwasny, Werner [7 ]
Reiner, Georg [8 ]
Greil, Richard [9 ]
Dubsky, Peter [3 ]
Poestlberger, Sabine [4 ]
Tschmelitsch, Joerg [5 ]
Samonigg, Hellmut [6 ]
Gnant, Michael [3 ]
机构
[1] Innsbruck Med Univ, Dept Gynecol, A-6020 Innsbruck, Austria
[2] Med Univ Vienna, Dept Internal Med, Vienna, Austria
[3] Med Univ Vienna, Dept Surg, Vienna, Austria
[4] BHS Linz, Dept Surg, Linz, Austria
[5] Krankenhaus St Veit Glan, Dept Surg, St Veit Glan, Austria
[6] Med Univ Graz, Dept Internal Med, Graz, Austria
[7] Wiener Neustadt Hosp, Dept Surg, Wiener Neustadt, Austria
[8] Donau Hosp SMZ Ost, Dept Surg, Vienna, Austria
[9] Salzburg Hosp, Dept Med 3, Salzburg, Austria
关键词
preoperative chemotherapy; breast cancer; CMF; EC; postoperative chemotherapy; response;
D O I
10.1007/s10549-007-9844-9
中图分类号
R73 [肿瘤学];
学科分类号
100214 [肿瘤学];
摘要
Purpose To evaluate the impact that pre- and postoperatively administered chemotherapy with cyclophosphamide, methotrexate and fluorouracil (CMF) and postoperative chemotherapy vs. postoperative chemotherapy alone have on long-term prognosis. Patients and Methods The ABCSG conducted a nationwide randomized phase III trial in high-risk endocrine non-responsive breast cancer patients comparing pre- and postoperative chemotherapy containing CMF as preoperative treatment vs. postoperative chemotherapy alone between 1991 and 1999. From 1996 the ABCSG-07 protocol was amended to also allow randomization of high-risk endocrine-responsive patients. Of 423 eligible patients with high-risk primary breast cancer, 203 patients were randomly assigned to preoperatively receive three cycles of CMF (cyclophosphamide, methotrexate, fluorouracil; 600/40/600 mg/m(2)) intravenously on day 1 and 8, while 195 patients received postoperative chemotherapy alone. In both groups, three cycles of CMF were given initially, and another three cycles of CMF were administered in node-negative patients, whereas node-positive patients received three cycles of EC (epirubicin, cyclophosphamide; 70/600 mg/m(2)). Results Overall response rate to preoperative chemotherapy with three cycles of CMF was 56.2%; complete pathological response was achieved in 12 patients (5.9%). Recurrence-free survival was significantly better in patients receiving chemotherapy postoperatively (HR 0.7, 0.515-0.955; P = 0.024). No survival difference was observed between the two therapy groups (HR 0.800, 0.563-1.136; P = 0.213). Discussion Preoperative chemotherapy with CMF has to be considered as insufficient in high-risk breast cancer patients. Delayed surgery and anthracycline-based chemotherapy result in shorter recurrence-free survival but not overall survival.
引用
收藏
页码:309 / 316
页数:8
相关论文
共 26 条
[1]
Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27 [J].
Bear, HD ;
Anderson, S ;
Smith, RE ;
Geyer, CE ;
Mamounas, EP ;
Fisher, B ;
Brown, AM ;
Robidoux, A ;
Margolese, R ;
Kahlenberg, MS ;
Paik, S ;
Soran, A ;
Wickerham, DL ;
Wolmark, N .
JOURNAL OF CLINICAL ONCOLOGY, 2006, 24 (13) :2019-2027
[2]
The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: Preliminary results from national surgical adjuvant breast and bowel project protocol B-27 [J].
Bear, HD ;
Anderson, S ;
Brown, A ;
Smith, R ;
Mamounas, EP ;
Fisher, B ;
Margolese, R ;
Theoret, H ;
Soran, A ;
Wickerham, DL ;
Wolmark, N .
JOURNAL OF CLINICAL ONCOLOGY, 2003, 21 (22) :4165-4174
[3]
BONADONNA G, 1991, SEMIN ONCOL, V18, P515
[4]
SYSTEMIC THERAPY IN RESECTABLE BREAST-CANCER [J].
BONADONNA, G ;
VALAGUSSA, P .
HEMATOLOGY-ONCOLOGY CLINICS OF NORTH AMERICA, 1989, 3 (04) :727-742
[5]
Short and long-term effects on survival in breast cancer patients treated by primary chemotherapy:: an updated analysis of a randomized trial [J].
Broët, P ;
Scholl, SM ;
de la Rochefordière, A ;
Fourquet, A ;
Moreau, T ;
De Rycke, Y ;
Asselain, B ;
Pouillart, P .
BREAST CANCER RESEARCH AND TREATMENT, 1999, 58 (02) :151-156
[6]
Comparison of anastrozole versus tamoxifen as preoperative therapy in postmenopausal women with hormone receptor-positive breast cancer - The Pre-Operative "Arimidex" Compared to Tamoxilen (PROAC7) trial [J].
Cataliotti, L ;
Buzdar, AU ;
Noguchi, S ;
Bines, J ;
Takatsuka, Y ;
Petrakova, K ;
Dube, P ;
de Oliveira, CT .
CANCER, 2006, 106 (10) :2095-2103
[7]
Chemotherapy is more effective in patients with breast cancer not expressing steroid hormone receptors:: A study of preoperative treatment [J].
Colleoni, M ;
Viale, G ;
Zahrieh, D ;
Pruneri, G ;
Gentilini, O ;
Veronesi, P ;
Gelber, RD ;
Curigliano, G ;
Torrisi, R ;
Luini, A ;
Intra, M ;
Galimberti, V ;
Renne, G ;
Nolè, F ;
Peruzzotti, G ;
Goldhirsch, A .
CLINICAL CANCER RESEARCH, 2004, 10 (19) :6622-6628
[8]
Preoperative treatment of postmenopausal breast cancer patients with letrozole: A randomized double-blind multicenter study [J].
Eiermann, W ;
Paepke, S ;
Appfelstaedt, J ;
Llombart-Cussac, A ;
Eremin, J ;
Vinholes, J ;
Mauriac, L ;
Ellis, M ;
Lassus, M ;
Chaudri-Ross, HA ;
Dugan, M ;
Borgs, M ;
Semiglazov, V .
ANNALS OF ONCOLOGY, 2001, 12 (11) :1527-1532
[9]
Breast cancer response to neoadjuvant chemotherapy: predictive markers and relation with outcome [J].
Faneyte, IF ;
Schrama, JG ;
Peterse, JL ;
Remijnse, PL ;
Rodenhuis, S ;
van der Vijver, MJ .
BRITISH JOURNAL OF CANCER, 2003, 88 (03) :406-412
[10]
Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: Findings from National Surgical Adjuvant Breast and Bowel Project B-18 [J].
Fisher, B ;
Brown, A ;
Mamounas, E ;
Wieand, S ;
Robidoux, A ;
Margolese, RG ;
Cruz, AB ;
Fisher, ER ;
Wickerham, DL ;
Wolmark, N ;
DeCillis, A ;
Hoehn, JL ;
Lees, AW ;
Dimitrov, NV .
JOURNAL OF CLINICAL ONCOLOGY, 1997, 15 (07) :2483-2493