Skip to main content
SpringerLink
Log in

Does induction chemotherapy with a mitoxantrone/vinorelbine regimen allow a breast-conservative treatment in patients with operable locoregional breast cancer?

A French Northern Oncology Group trial in 105 patients

Breast Cancer Research and Treatment volume 40, pages 161–169 (1996)Cite this article

Abstract

Background

In recent years, induction chemotherapy has been tested by several investigators in the management of operable breast cancer.

Patients and methods

Our current study was aimed to evaluate, pragmatically, in patients (74 stage II and 30 stage III) whose treatment would have been mastectomy, the percentage of them in whom a conservative treatment can be performed if primarily treated with a mitoxantrone/vinorelbine regimen.

Results

67/104 patients (64%; 95% CI: 55–74%) had a conservative treatment (lumpectomy: 54, radiation therapy: 12, radiation therapy then lumpectomy: 1). Neutropenia was the major dose-limiting side effect, with grade 3 or 4 neutropenia registered in 83% of patients and 53.3% of the 442 cycles. Overall, a grade 3 or 4 non hematologic side effect occurred in 19.8% of patients and in 9.1% of cycles. One toxic death was observed after 2 cycles in a patient with aplasia who developped septicemia. Seventy one per cent of the patients experienced nausea and vomiting but grade 3 were observed in only 12% of the patients. Other side effects, including stomatitis, asthenia, alopecia, and constipation, were generally mild and uncommon.

Conclusions

This mitoxantrone/vinorelbine regimen is an efficient induction treatment with only neutropenia as a noticeable side effect. It allows 64% of conservative treatment in patients whose treatment would have been mastectomy.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Hortobagyi GN, Ames FC, Buzdar AU, Kau SW, Mac Neese RN, Paulus D, Holmes FA, Romsdahl MM, Fraschini G, Mac Bride CM, Martin RG, Montague E: Management of stage III primary breast cancer with primary chemotherapy, surgery, and radiation therapy. Cancer 62: 2507–2516, 1988

    PubMed  Google Scholar 

  2. Jacquillat C, Weil M, Baillet F, Borel C, Auclerc G, de Maublanc MA, Housset M, Forget G, Thill L, Soubrane C, Khayat D: Results of neoadjuvant chemotherapy and radiation therapy in the breast-conserving treatment of 250 patients with all stages of infiltrative breast cancer. Cancer 66: 119–129, 1990

    PubMed  Google Scholar 

  3. Bélembaogo E, Feillel V, Chollet P, Curé H, Verrelle P, Kwiatkowski F, Achard JL, Le Bouedec G, Chassagne J, Bignon YJ, de Latour M, Lafaye C, Dauplat J: Neoadjuvant chemotherapy in 126 operable breast cancer. Eur J Cancer 28A: 896–900, 1992

    PubMed  Google Scholar 

  4. Bonnadonna G: From adjuvant to neo-adjuvant chemotherapy in high-risk breast cancer: the experience of the Milan Cancer Institute. Steimer Award lecture 1992. Int J Cancer 55: 1–4, 1993

    PubMed  Google Scholar 

  5. Mauriac L, Durand M, Avril A, Dilhuydy JM: Effects of primary chemotherapy in conservative treatment of breast cancer patients with operable tumors larger than 3 cm. Ann Oncol 2: 347–354, 1991

    PubMed  Google Scholar 

  6. Smith IE, Jones AI, O'Brien MER, Mc Kinna JA, Sacks N, Baum M. Primary medical (neoadjuvant) chemotherapy for operable breast cancer. Eur J Cancer 29A: 592–595, 1993

    Google Scholar 

  7. Calais G, Berger C, Descamps P, Chapet S, Reynaud-Bougnoux A, Body G, Bougnoux P, Lansac J, Le Floch O: Conservative treatment feasibility with induction chemotherapy, surgery, and radiotherapy for patients with breast carcinoma larger than 3 cm. Cancer 74: 1283–1288, 1994

    PubMed  Google Scholar 

  8. Scholl SM, Fourquet A, Asselain B, Pierga JY, Vilcoq JR, Durand JC, Dorval T, Palangié T, Jouve M, Beuzeboc P, Garcio-Giralt E, Salmon RJ, de la Rochefordière A, Campana F, Pouillart P: Neoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumours considered too large for breast conserving surgery: preliminary results of a randomised trial: S6, Eur J Cancer 30A: 645–652, 1994

    PubMed  Google Scholar 

  9. Smith IE, Walsh G, Jones A, Prendiville J, Johnston S, Gusterson B, Ramage F, Robertshaw H, Sacks N, Ebbs S, Mc Kinna JA, Baum M: High complete remission rates with primary neoadjuvant infusional chemotherapy for large early breast cancer. J Clin Oncol 13: 424–429, 1995

    PubMed  Google Scholar 

  10. Goldie JH, Coldman A: A mathematical model for relating the drug sensitivity of tumors to their spontaneous mutation rate. Cancer Treat Rep 63: 1727–1733, 1979

    PubMed  Google Scholar 

  11. Kurtz JM: Should surgery remain the initial treatment of operable breast cancer? Eur J Cancer 27: 1539–1542, 1991

    PubMed  Google Scholar 

  12. Chabner BA, Myers CE: Antitumor Antibiotics. In: DeVita VT Jr, Hellman S, Rosenberg SA (eds) Cancer: principles and practice of oncology (ed 4). Philadelphia, PA, Lippincott, 1993, pp 374–384

    Google Scholar 

  13. Coleman RE, Maisey MN, Knight RK, Rubens RD: Mitoxantrone in advanced breast cancer: a phase II study with special attention to cardiotoxicity. Eur J Cancer Clin Oncol 6: 771–776, 1984

    Google Scholar 

  14. Harris AL, Cantwell BMJ, Carmichael J, Wilson R, Farndon J, Dawes P, Ghani S, Evans RGB: Comparison of short-term and continuous chemotherapy (mitozantrone) for advanced breast cancer. Lancet 335: 186–190, 1990

    PubMed  Google Scholar 

  15. Wilson KS, Paterson AHG: First-line mitoxantrone chemotherapy for advanced brast cancer. Cancer Treat Rep 70: 1021–1022, 1986

    PubMed  Google Scholar 

  16. Mouridsen HT, Cornbleet M, Stuart-Harris R, Smith I, Coleman R, Rubens R, McDonald M, Rainer H, van Oosterom A, Smyth J: Mitoxantrone as first-line chemotherapy in advanced breast cancer: results of a collaborative European study. Invest New Drugs 3: 139–148, 1985

    PubMed  Google Scholar 

  17. Cowan JD, Neidhart JA, McClure S, Coltman CA, Gumbart C, Martino S, Hutchins LF, Stephens RL, Vaughan CB, Osborne CK: Randomized trial of doxorubicin bisantrene, and mitoxantrone in advanced breast cancer: a Southwest Oncology Group Study. J Natl Cancer Inst 83: 1077–1084, 1991

    PubMed  Google Scholar 

  18. Neidhart JA, Gochnour D, Roach R, Hoth D, Young D: A comparison of mitoxantrone and doxorubicin in breast cancer. J Clin Oncol 4: 672–677, 1986

    PubMed  Google Scholar 

  19. Henderson IC, Allegra JC, Woodcock T, Wolff S, Bryan S, Cartwright K, Dukart G, Henry D: Randomized clinical trial comparing mitoxantrone with doxorubicin in previously treated patients with metastatic breast cancer. J Clin Oncol 7: 560–571, 1989

    PubMed  Google Scholar 

  20. Pouillart P, Follézou JY, Palangie T, Feuilhade F, George C, Richard E: Long-term results of a randomized trial comparing regimens of cyclophosphamide and fluorouracil with either mitoxantrone or doxorubicin in patients with advanced breast cancer. Eur J Cancer 30A: 715–716, 1994

    PubMed  Google Scholar 

  21. Bennett JM, Muss HB, Doroshow JH, Wolff S, Krementz ET, Cartwright K, Dukart G, Reisman A, Schoch I: A randomized multicenter trial comparing mitoxantrone, cyclophosphamide and 5-fluorouracil and doxorubicin, cyclophosphamide and 5-fluorouracil in the therapy of metastatic breast cancer. J Clin Oncol 6: 1611–1620, 1988

    PubMed  Google Scholar 

  22. Fumoleau P, Delgado FM, Delozier T, Monnier A, Gil Delgado MA, Kerbrat P, Garcia-Giralt E, Keiling R, Namer M, Closon MT, Goudier MJ, Chollet P, Lecourt L, Montcuquet P: Phase II trial of weekly intravenous vinorelbine in firstline advanced breast cancer chemotherapy. J Clin Oncol 11: 1245–1252, 1993

    PubMed  Google Scholar 

  23. Degardin M, Bonneterre J, Hecquet B, Pion JM, Adenis A, Horner D, Demaille A: Vinorelbine (Navelbine) as a salvage treatment for advanced breast cancer. Ann Oncol 5: 423–426, 1994

    PubMed  Google Scholar 

  24. Spielmann M, Brain E, Sari C: Salvage chemotherapy (CT) with combination of mitoxantrone (MTZ) and vinorelbine (VNR) in resistant to anthracyclines advanced breast cancer (ABC). Fourth International Congress on Neoadjuvant Chemotherapy, Paris, France, February 2–5, 1993 (abstr 14)

  25. Ferrero JM, Pivot X, Namer M, Wendling JL, Frenay M, Francois E, Hoch M, Teissier E: Mitoxantrone-vinorelbine as first line chemotherapy in metastatic breast cancer. Bull Cancer 82: 202–207, 1995

    PubMed  Google Scholar 

  26. Spielmann M, Dorval T, Turpin F, Antoine E, Jouve M, MayLevin F, Lacombe D, Rouesse J, Pouillart P, Tursz T, Merle S: Phase II trial of vinorelbine-doxorubicin as first-line therapy of advanced breast cancer. J Clin Oncol 12: 1764–1770, 1994

    PubMed  Google Scholar 

  27. Miller AB, Hoogstraten B, Staquet M, Winkeler A: Reporting results of cancer treatment. Cancer 47: 207–214, 1981

    PubMed  Google Scholar 

  28. Powles TJ, Hickish TF, Makris A, Ashley SE, O'Brien MER, Tidy VA, Casey S, Nash AG, Sacks N, Cosgrove D, Mac Vicar D, Fernando I, Ford HT: Randomized trial of chemoendocrine therapy started before or after surgery for treatment of primary breast cancer. J Clin Oncol 13: 547–552, 1995

    PubMed  Google Scholar 

  29. Quesnel B, Kantarjian H, Bjergaard JP, Brault P, Estey E, Lai JL, Tilly H, Stoppa AM, Archimbaud E, Harousseau JL, Bauters F, Fenaux P: Therapy-related acute myeloid leukemia with t(8;21), inv(16), and t(8; 16): a report on 25 cases and review of the literature. J Clin Oncol 11: 2370–2379, 1993

    PubMed  Google Scholar 

  30. Ragaz J, Aird R, Goldie J, Coldman A, Lee N, Worth A: (Preoperative neoadjuvant) therapy for breast cancer. Early results of the northamerican studies. International Symposium on Neoadjuvant treatment of Surgical Breast carcinoma. Madrid, 3/25/1994 (abstract)

  31. Fisher B: Preoperative chemotherapy: a model for studying the biology and therapy of primary breast cancer. J Clin Oncol 13: 537–540, 1995

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. French Northern Oncology Group, Centre Oscar Lambret (Northern France Cancer Center), BP 307, 59020, Lille Cedex, France

    Antoine Adenis, Laurence Vanlemmens, Charles Fournier, Bernard Hecquet & Jacques Bonneterre

Authors
  1. Antoine Adenis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laurence Vanlemmens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charles Fournier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bernard Hecquet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jacques Bonneterre
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf the French Northern Oncology Group

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Adenis, A., Vanlemmens, L., Fournier, C. et al. Does induction chemotherapy with a mitoxantrone/vinorelbine regimen allow a breast-conservative treatment in patients with operable locoregional breast cancer?. Breast Cancer Res Tr 40, 161–169 (1996). https://doi.org/10.1007/BF01806211

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01806211

Key words

search

Navigation