Abstract
Background
We have been treating hormone receptor-positive, postmenopausal women with breast cancer with a regimen of neoadjuvant chemotherapy (NAC), FEC (fluorouracil, epirubicin, and cyclophosphamide), followed by weekly doses of paclitaxel combined with the concurrent administration of anastrozole. In this article, we compared our results retrospectively with those of past trials.
Methods
Twenty-six patients that were postmenopausal and were younger than 70 years of age were selected. They all had primary operable tumors that were ≥2 cm in diameter (clinical T2–3, Nx, M0). All patients received four cycles of 500 mg/m2 cyclophosphamide, 500 mg/m2 5-fluorouracil, and 80 mg/m2 epirubicin (from April 2006, the dose was increased to 100 mg/m2) that were administrated on day 1 of every 3rd week and followed by 12 cycles of 80 mg/m2 paclitaxel on day 1 of each week. From the beginning of NAC the aromatase inhibitor, anastrozole, was concomitantly administered at a dose of 1 mg/day. After surgery, the clinical and pathological responses were examined.
Results
Among the 26 patients, 5 (17.9%) achieved clinical complete response, 16 (57.1%) clinical partial response, and 4 (14.3%) clinical stable disease. If the nodal status was counted, the pathological complete response (pCR) rate of our chemo-endocrine therapy was 11.5%.
Conclusions
The pCR rate of the concurrent administration of chemo-endocrine therapy was not lower than those of past trials, but it remains uncertain whether this positive result was due to the administration of the aromatase inhibiter or our NAC regimen. In order to answer this, we need to make a direct comparison between the concurrent versus sequential administration of the aromatase inhibitor during NAC in a prospective study.
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References
Fisher B, Bryant J, Wolmark N, Mamounas E, Brown A, Fisher ER, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol. 1998;16:2672–85.
Kuerer HM, Newman LA, Smith TL, Ames FC, Hunt KK, Dhingra K, et al. 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;17:460–9.
Pierga JY, Mouret E, Dieras V, Laurence V, Beuzeboc P, Dorval T, et al. Prognostic value of persistent node involvement after neoadjuvant chemotherapy in patients with operable breast cancer. Br J Cancer. 2000;83:1480–7.
Bear HD, Anderson S, Brown A, Smith R, Mamounas EP, Fisher B, et al. 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 Clin Oncol. 2003;21:4165–74.
Colleoni M, Viale G, Zahrieh D, Pruneri G, Gentilini O, Veronesi P, et al. Chemotherapy is more effective in patients with breast cancer not expressing steroid hormone receptors: a study of preoperative treatment. Clin Cancer Res. 2004;10:6622–8.
Fisher ER, Wang J, Bryant J, Fisher B, Mamounas E, Wolmark N. Pathobiology of preoperative chemotherapy: findings from the National Surgical Adjuvant Breast and Bowel (NSABP) protocol B-18. Cancer. 2002;95:681–95.
Guarneri V, Broglio K, Kau SW, Cristofanilli M, Buzdar AU, Valero V, et al. Prognostic value of pathologic complete response after primary chemotherapy in relation to hormone receptor status and other factors. J Clin Oncol. 2006;24:1037–44.
Osborne CK. Combined chemo-hormonal therapy in breast cancer: a hypothesis. Breast Cancer Res Treat. 1981;1:121–3.
Albain K, Green S, Ravdin P (eds). Adjuvant chemohormonal therapy for primary breast cancer should be sequential instead of concurrent: initial results from intergroup trial 0100 (SWOG-8814). Proc Am Soc Clin Oncol. 2002.
Smith IE, Dowsett M, Ebbs SR, Dixon JM, Skene A, Blohmer JU, et al. Neoadjuvant treatment of postmenopausal breast cancer with anastrozole, tamoxifen, or both in combination: the Immediate Preoperative Anastrozole, Tamoxifen, or Combined with Tamoxifen (IMPACT) multicenter double-blind randomized trial. J Clin Oncol. 2005;23:5108–16.
Eiermann W, Paepke S, Appfelstaedt J, Llombart-Cussac A, Eremin J, Vinholes J, et al. Preoperative treatment of postmenopausal breast cancer patients with letrozole: a randomized double-blind multicenter study. Ann Oncol. 2001;12:1527–32.
Kim R, Tanabe K, Emi M, Uchida Y, Osaki A, Toge T. Rationale for sequential tamoxifen and anticancer drugs in adjuvant setting for patients with node- and receptor-positive breast cancer. Int J Oncol. 2005;26:1025–31.
Tabuchi Y, Matsuoka J, Gunduz M, Imada T, Ono R, Ito M, et al. Resistance to paclitaxel therapy is related with Bcl-2 expression through an estrogen receptor mediated pathway in breast cancer. Int J Oncol. 2009;34:313–9.
Dowsett M, Cuzick J, Howell A, Jackson I. Pharmacokinetics of anastrozole and tamoxifen alone, and in combination, during adjuvant endocrine therapy for early breast cancer in postmenopausal women: a sub-protocol of the ‘Arimidex and tamoxifen alone or in combination’ (ATAC) trial. Br J Cancer. 2001;85:317–24.
Dixon JM, Renshaw L, Young O, Murray J, Macaskill EJ, McHugh M, et al. Letrozole suppresses plasma estradiol and estrone sulphate more completely than anastrozole in postmenopausal women with breast cancer. J Clin Oncol. 2008;26:1671–6.
JCOG. Common Terminology Criteria for Adverse Events v3.0 (CTCAE v3.0). JCOG; 2007/3/8 [updated 2007/3/8; cited 2008]. Available from: http://www.jcog.jp/SHIRYOU/ctcae.htm.
Pico C, Martin M, Jara C, Barnadas A, Pelegri A, Balil A, et al. Epirubicin-cyclophosphamide adjuvant chemotherapy plus tamoxifen administered concurrently versus sequentially: randomized phase III trial in postmenopausal node-positive breast cancer patients. A GEICAM 9401 study. Ann Oncol. 2004;15:79–87.
Del Mastro L, Dozin B, Aitini E, Catzeddu T, Baldini E, Contu A, et al. Timing of adjuvant chemotherapy and tamoxifen in women with breast cancer: findings from two consecutive trials of Gruppo Oncologico Nord-Ovest-Mammella Intergruppo (GONO-MIG) Group. Ann Oncol. 2008;19:299–307.
Yoshida M, Abe O, Uchino J, Kikuchi K, Abe R, Enomoto K, et al. Meta-Analysis of the Second Collaborative Study of Adjuvant Chemoendocrine Therapy for Breast Cancer (ACETBC) in Patients with Stage II, Estrogen-Receptor-Positive Breast Cancer. Breast Cancer. 1997;4:93–101.
Morimoto T, Ogawa M, Orita K, Sugimachi K, Toge T, Dohi K, et al. Postoperative adjuvant randomised trial comparing chemoendocrine therapy, chemotherapy and immunotherapy for patients with stage II breast cancer: 5-year results from the Nishinihon Cooperative Study Group of Adjuvant Chemoendocrine Therapy for Breast Cancer (ACETBC) of Japan. Eur J Cancer. 1996;32A:235–42.
Liedtke C, Mazouni C, Hess KR, Andre F, Tordai A, Mejia JA, et al. Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol. 2008;26:1275–81.
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Watanabe, N., Ootawa, Y., Kodama, K. et al. Concurrent administration of chemo-endocrine therapy for postmenopausal breast cancer patients. Breast Cancer 17, 247–253 (2010). https://doi.org/10.1007/s12282-009-0144-6
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DOI: https://doi.org/10.1007/s12282-009-0144-6