Inflammatory Breast Cancer-comparing the Effectivity of Preoperative Docetaxel-epirubicine Protocol to Conventional Antracycline-containing Chemotherapy to Achieve Clinical Benefit and Complete Pathological Response

Overview

Journal Pathol Oncol Res

Specialty Oncology

Date 2010 Dec 15

PMID 21153723

Authors

Zsolt Horvath

Laszlo Torday

Erika Hitre

Erna Ganofszky

Eva Juhos

Ferenc Czegledi

Laszlo Urban

Csaba Polgar

Istvan Lang

Sandor Eckhardt

Miklos Kasler

Affiliations

Soon will be listed here.

Abstract

Our retrospective analysis compared the effectiveness of conventional antracycline-containing protocols (A+) and docetaxel/epirubicine (TE) as primary systemic chemotherapies (PSCT) for inflammatory breast cancer (IBC). Seventy IBC patients received either A + (n = 48) or TE (n = 22) as PSCT. The objective clinical response and clinical benefit rate of treated patients were 54.3% (A+: 54,2% vs. TE: 54,5%; p = 0,28) and 92.8% (A+: 91,7% vs. TE: 95,5%; p = 0,57), respectively. The clinical complete response rate (cCR) was 23.2% (A+: 27,1% vs. TE:4,5%; χ (2) = 4,79; p = 0,03) with 7.14% (A+: 10,4% vs. TE:0%; χ (2) = 2,47; p = 0,12) of pathological complete responses (pCR). The median progression free (PFS)/local progression free (LPFS)/overall survival (OS) was 2.0/5.4/4.0 years, respectively. Patients achieving cCR had a tendency for better survival parameters than patients with less than cCR. Response rates or survival data were not statistically different in the two chemotherapy (CT) treatment groups. The survival was not influenced by the number of CT cycles in either protocols. In this set of patients, the clinical efficacy of the two alternative primary systemic chemotherapies (A + and TE) is equivalent in the treatment of inflammatory breast cancer (IBC), despite of the significant difference in favour of A + noticed in CRs. Six cycles of CT could be enough for patients achieving CR, however sequential pre- and/or postoperative CT with non cross-resistant drugs should be considered for non-responders.

References

Kuerer H, Newman L, Smith T, Ames F, Hunt K, Dhingra K . Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol. 1999; 17(2):460-9. DOI: 10.1200/JCO.1999.17.2.460. View

Amat S, Abrial S, Abrial C, Penault-Llorca F, Delva R, Bougnoux P . High prognostic significance of residual disease after neoadjuvant chemotherapy: a retrospective study in 710 patients with operable breast cancer. Breast Cancer Res Treat. 2005; 94(3):255-63. DOI: 10.1007/s10549-005-9008-8. View

Gralow J, Burstein H, Wood W, Hortobagyi G, Gianni L, von Minckwitz G . Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease. J Clin Oncol. 2008; 26(5):814-9. DOI: 10.1200/JCO.2007.15.3510. View

Cristofanilli M, Buzdar A, Sneige N, Smith T, Wasaff B, Ibrahim N . Paclitaxel in the multimodality treatment for inflammatory breast carcinoma. Cancer. 2001; 92(7):1775-82. DOI: 10.1002/1097-0142(20011001)92:7<1775::aid-cncr1693>3.0.co;2-e. View

Thomas E, Holmes F, Smith T, Buzdar A, Frye D, Fraschini G . The use of alternate, non-cross-resistant adjuvant chemotherapy on the basis of pathologic response to a neoadjuvant doxorubicin-based regimen in women with operable breast cancer: long-term results from a prospective randomized trial. J Clin Oncol. 2004; 22(12):2294-302. DOI: 10.1200/JCO.2004.05.207. View

Chevallier B, Bastit P, Graic Y, Menard J, Dauce J, Julien J . The Centre H. Becquerel studies in inflammatory non metastatic breast cancer. Combined modality approach in 178 patients. Br J Cancer. 1993; 67(3):594-601. PMC: 1968283. DOI: 10.1038/bjc.1993.109. View

Hance K, Anderson W, Devesa S, Young H, Levine P . Trends in inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program at the National Cancer Institute. J Natl Cancer Inst. 2005; 97(13):966-75. PMC: 2844937. DOI: 10.1093/jnci/dji172. View

Evans T, Yellowlees A, Foster E, Earl H, Cameron D, Hutcheon A . Phase III randomized trial of doxorubicin and docetaxel versus doxorubicin and cyclophosphamide as primary medical therapy in women with breast cancer: an anglo-celtic cooperative oncology group study. J Clin Oncol. 2005; 23(13):2988-95. DOI: 10.1200/JCO.2005.06.156. View

Ueno N, Buzdar A, Singletary S, Ames F, McNeese M, Holmes F . Combined-modality treatment of inflammatory breast carcinoma: twenty years of experience at M. D. Anderson Cancer Center. Cancer Chemother Pharmacol. 1997; 40(4):321-9. DOI: 10.1007/s002800050664. View

10.

Chang S, Parker S, Pham T, Buzdar A, Hursting S . Inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program of the National Cancer Institute, 1975-1992. Cancer. 1998; 82(12):2366-72. View

11.

Rouzier R, Pusztai L, Delaloge S, Gonzalez-Angulo A, Andre F, Hess K . Nomograms to predict pathologic complete response and metastasis-free survival after preoperative chemotherapy for breast cancer. J Clin Oncol. 2005; 23(33):8331-9. DOI: 10.1200/JCO.2005.01.2898. View

12.

Panades M, Olivotto I, Speers C, Shenkier T, Olivotto T, Weir L . Evolving treatment strategies for inflammatory breast cancer: a population-based survival analysis. J Clin Oncol. 2005; 23(9):1941-50. DOI: 10.1200/JCO.2005.06.233. View

13.

Voordeckers M, Vinh-Hung V, Van De Steene J, Lamote J, Storme G . The lymph node ratio as prognostic factor in node-positive breast cancer. Radiother Oncol. 2004; 70(3):225-30. DOI: 10.1016/j.radonc.2003.10.015. View

14.

Damast S, Ho A, Montgomery L, Fornier M, Ishill N, Elkin E . Locoregional outcomes of inflammatory breast cancer patients treated with standard fractionation radiation and daily skin bolus in the taxane era. Int J Radiat Oncol Biol Phys. 2009; 77(4):1105-12. DOI: 10.1016/j.ijrobp.2009.06.042. View

15.

Bauer R, BUSCH E, Levine E, Edge S . Therapy for inflammatory breast cancer: impact of doxorubicin-based therapy. Ann Surg Oncol. 1995; 2(4):288-94. DOI: 10.1007/BF02307059. View

16.

Cristofanilli M, Valero V, Buzdar A, Kau S, Broglio K, Gonzalez-Angulo A . Inflammatory breast cancer (IBC) and patterns of recurrence: understanding the biology of a unique disease. Cancer. 2007; 110(7):1436-44. DOI: 10.1002/cncr.22927. View

17.

von Minckwitz G, Kummel S, Vogel P, Hanusch C, Eidtmann H, Hilfrich J . Intensified neoadjuvant chemotherapy in early-responding breast cancer: phase III randomized GeparTrio study. J Natl Cancer Inst. 2008; 100(8):552-62. DOI: 10.1093/jnci/djn089. View

18.

Steger G, Galid A, Gnant M, Mlineritsch B, Lang A, Tausch C . Pathologic complete response with six compared with three cycles of neoadjuvant epirubicin plus docetaxel and granulocyte colony-stimulating factor in operable breast cancer: results of ABCSG-14. J Clin Oncol. 2007; 25(15):2012-8. DOI: 10.1200/JCO.2006.09.1777. View

19.

Baldini E, Gardin G, Giannessi P, Evangelista G, Roncella M, Prochilo T . Accelerated versus standard cyclophosphamide, epirubicin and 5-fluorouracil or cyclophosphamide, methotrexate and 5-fluorouracil: a randomized phase III trial in locally advanced breast cancer. Ann Oncol. 2003; 14(2):227-32. DOI: 10.1093/annonc/mdg069. View

20.

Manga G, Khosravi Shahi P, Urena M, Pereira R, Plaza M, Izarzugaza Peron Y . Phase II study of neoadjuvant treatment with doxorubicin, docetaxel, and capecitabine (ATX) in locally advanced or inflammatory breast cancer. Breast Cancer. 2009; 17(3):205-11. DOI: 10.1007/s12282-009-0136-6. View