Breast Cancer Research and Treatment

, Volume 113, Issue 3, pp 479–490

Fifteen-year median follow-up results after neoadjuvant doxorubicin, followed by mastectomy, followed by adjuvant cyclophosphamide, methotrexate, and fluorouracil (CMF) followed by radiation for stage III breast cancer: a phase II trial (CALGB 8944)

  • G. G. Kimmick
  • C. Cirrincione
  • D. B. Duggan
  • K. Bhalla
  • N. Robert
  • D. Berry
  • L. Norton
  • S. Lemke
  • I. C. Henderson
  • C. Hudis
  • E. Winer
  • On Behalf of the Cancer and Leukemia Group B
Clinical Trial

DOI: 10.1007/s10549-008-9943-2

Cite this article as:
Kimmick, G.G., Cirrincione, C., Duggan, D.B. et al. Breast Cancer Res Treat (2009) 113: 479. doi:10.1007/s10549-008-9943-2

Abstract

Purpose To describe long-term results of a multimodality strategy for stage III breast cancer utilizing neoadjuvant doxorubicin followed by mastectomy, CMF, and radiotherapy. Patients and methods Women with biopsy-proven, clinical stage III breast cancer and adequate organ function were eligible. Neoadjuvant doxorubicin (30 mg/m2 days 1–3, every 28 days for 4 cycles) was followed by mastectomy, in stable or responding patients. Sixteen weeks of postoperative CMF followed (continuous oral cyclophosphamide (2 mg/kg/day); methotrexate (0.7 mg/kg IV) and fluorouracil (12 mg/kg IV) weekly, weeks 1–8, and than biweekly, weeks 9–16). Radiation therapy followed adjuvant chemotherapy. Results Clinical response rate was 71% (79/111, 95% CI = 62–79%), with 19% complete clinical response. Pathologic complete response was 5% (95% CI = 2–11%). Median follow-up is 15.6 years. Half of the patients progressed by 2.2 years; half died by 5.4 years (range 6 months–15 years). The hazard of dying was greatest in the first 5 years after diagnosis and declined thereafter. Time to progression and overall survival were predicted by number of pathologically involved lymph nodes (TTP: HR [10 vs. 1 node] 2.40, 95% CI = 1.63–3.53, P < 0.0001; OS: HR 2.50, 95% CI = 1.74–3.58, P < 0.0001). Conclusions After multimodality treatment for locally advanced breast cancer, long-term survival was correlated with the number of pathologically positive lymph nodes, but not to clinical response. The hazard of death was highest during the first 5 years after diagnosis and declined thereafter, indicating a possible intermediate endpoint for future trials of neoadjuvant treatment.

Keywords

Breast cancerChemotherapyLocally advancedLong-term follow-upNeoadjuvantStage III

Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • G. G. Kimmick
    • 1
  • C. Cirrincione
    • 2
  • D. B. Duggan
    • 3
  • K. Bhalla
    • 4
  • N. Robert
    • 5
  • D. Berry
    • 6
  • L. Norton
    • 7
  • S. Lemke
    • 3
  • I. C. Henderson
    • 8
  • C. Hudis
    • 7
  • E. Winer
    • 9
  • On Behalf of the Cancer and Leukemia Group B
    • 10
  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.CALGB Statistical CenterDuke University Medical CenterDurhamUSA
  3. 3.SUNY Upstate Medical UniversitySyracuseUSA
  4. 4.H. Lee Moffitt Cancer CenterTampaUSA
  5. 5.Inova Fairfax Hospital Institute of ResearchFalls ChurchUSA
  6. 6.Department of BiostatisticsMD Anderson Cancer CenterHoustonUSA
  7. 7.Memorial Sloan Kettering Cancer CenterNew YorkUSA
  8. 8.University of California San FranciscoSan FranciscoUSA
  9. 9.Dana Farber Cancer InstituteBostonUSA
  10. 10.ChicagoUSA