Breast Cancer Research and Treatment

, Volume 112, Issue 2, pp 309–316

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)

  • Susanne Taucher
  • Guenther G. Steger
  • Raimund Jakesz
  • Christoph Tausch
  • Viktor Wette
  • Walter Schippinger
  • Werner Kwasny
  • Georg Reiner
  • Richard Greil
  • Peter Dubsky
  • Sabine Poestlberger
  • Joerg Tschmelitsch
  • Hellmut Samonigg
  • Michael Gnant
Clinical Trial

Abstract

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/m2) 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/m2). 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.

Keywords

Preoperative chemotherapy Breast cancer CMF EC Postoperative chemotherapy Response 

Copyright information

© Springer Science+Business Media, LLC. 2007

Authors and Affiliations

  • Susanne Taucher
    • 1
  • Guenther G. Steger
    • 2
  • Raimund Jakesz
    • 3
  • Christoph Tausch
    • 4
  • Viktor Wette
    • 5
  • Walter Schippinger
    • 6
  • Werner Kwasny
    • 7
  • Georg Reiner
    • 8
  • Richard Greil
    • 9
  • Peter Dubsky
    • 3
  • Sabine Poestlberger
    • 4
  • Joerg Tschmelitsch
    • 5
  • Hellmut Samonigg
    • 6
  • Michael Gnant
    • 3
  1. 1.Department of GynecologyInnsbruck Medical UniversityInnsbruckAustria
  2. 2.Department of Internal MedicineMedical University ViennaViennaAustria
  3. 3.Department of SurgeryMedical University ViennaViennaAustria
  4. 4.Department of SurgeryBHS LinzLinzAustria
  5. 5.Department of SurgeryKrankenhaus St.Veit/Glan St.Veit/GlanAustria
  6. 6.Department of Internal MedicineMedical University GrazGrazAustria
  7. 7.Department of SurgeryWiener Neustadt Hospital Wiener NeustadtAustria
  8. 8.Department of SurgeryDonau-Hospital SMZ-OstViennaAustria
  9. 9.Third Medical DepartmentSalzburg HospitalSalzburgAustria

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