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Annals of Oncology Advance Access originally published online on August 9, 2005
Annals of Oncology 2005 16(11):1778-1785; doi:10.1093/annonc/mdi360
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© 2005 European Society for Medical Oncology

Neoadjuvant chemotherapy with infusional 5-fluorouracil, adriamycin and cyclophosphamide (iFAC) in locally advanced breast cancer: an early response predicts good prognosis

Y. W. Moon1, S. Y. Rha1,4, H. C. Jeung1, W. I. Yang2,4, C. O. Suh3,4 and H. C. Chung1,4,*

Cancer Metastasis Research Center, Yonsei Cancer Center, Departments of 1 Internal Medicine, 2 Pathology, 3 Radiation Oncology and 4 Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea

* Correspondence to: Dr H. C. Chung, Yonsei Cancer Center, Cancer Metastasis Research Center, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-02-361-7623; Fax: +82-02-393-3652; E-mail: unchang8{at}yumc.yonsei.ac.kr

Background: The aim of this study was to evaluate the efficacy and safety of neoadjuvant chemotherapy with infusional 5-fluorouracil (5-FU), adriamycin and cyclophosphamide (iFAC) in locally advanced breast cancer (LABC).

Patients and methods: Eighty-two LABC patients were treated with neoadjuvant iFAC chemotherapy including infusional 5-FU (1000 mg/m2, continuous intravenous infusion, days 1–3), adriamycin (40 mg/m2, intravenous bolus, day 1) and cyclophosphamide (600 mg/m2, intravenous bolus, day 1) every 3 weeks until maximum tumor response. Patients subsequently received surgery, adjuvant chemotherapy, radiotherapy and hormonal therapy as appropriate.

Results: Downstaging occurred in 71 of the 82 patients (86.6%). Seventy-two patients (67 patients with downstaging and five patients without downstaging) were resectable (resectability rate, 87.8%). The clinical response rate was 84.2%, with a complete response (CR) rate of 17.1% and a pathological CR rate of 7.8%. During 891 cycles of chemotherapy, the most common grade 3/4 hematological toxicity was leukopenia (36.0%). There were no treatment-related deaths. The median follow-up period was 51 months, with a median overall survival (OS) of 66 months, and a 5 year OS rate of 50.9% for all patients. The 5 year OS and disease-free survival (DFS) rates of the 64 patients who underwent surgery were 55.8% and 44.7%, respectively.

Conclusions: Neoadjuvant chemotherapy with iFAC had a comparable response rate and DFS to the conventional bolus FAC regimen, with an acceptable toxicity in LABC using the AJCC 2002 staging system. An early response to neoadjuvant iFAC was a favorable prognostic factor.

Key words: adriamycin, cyclophosphamide, infusional 5-fluorouracil, locally advanced breast cancer, neoadjuvant chemotherapy


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