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Annals of Oncology 10:305-301, 1999
© 1999 European Society for Medical Oncology

research-article

Combined sequential approach in locally advanced breast cancer

M. Zambetti, S. Oriana, P. Quattrone, P. Verderio, M. Terenziani, R. Zucali, P. Valagussa and G. Bonadonna

Istituto Nazionale Tumori Milano, Italy

M. Zambetti, MD, Istituto Nationale Tumori, Via Venezian I, 20133 Milan, Italy

Background: The interaction between primary and adjuvant chemotherapy is a crucial point in the treatment of locally advanced breast cancer.

Objective: To evaluate the therapeutic efficacy of a sequential treatment with primary anthracyclines and adjuvant CMF in this patient subset.

Design: Prospective cohort study.

Patients: Eighty-eight breast cancer patients, stage T3b-T4 abc, N0–2, M0. Results: From February 1991 to July 1994, 88 consecutive patients with locally advanced breast cancer were treated at the Istituto Nazionale Tumori, Milano, with full-dose doxo-rubicin (75 mg/m2) or epirubicin (120 mg/m2) for three cycles followed by surgery, adjuvant chemotherapy with i.v. CMF for six cycles and local radiotherapy ± Tamoxifen. A high rate of objective responses (70%), but a low incidence of pathologic complete remission (2%), were observed following primary treatment with single-agent anthracyclines. Frequency of responses was not associated with tumor estrogen or progesterone receptors status, Mib-1 or grading. In 28 patients (32%) conservative surgery could be performed. At a median follow-up of 52 months, relapse free survival and overall survival are 52% and 62%, respectively. A multivariate analysis demonstrated a significant favorable prognosis in patients with limited nodal involvement at surgery and negative Mib-1 values. This drug sequence failed to significantly ameliorate the long term results in this unfavorable patient subset and more effective drug regimens and innovative therapeutic strategies are needed.

conservative surgery, locally advanced breast cancer, primary chemotherapy


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