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Annals of Oncology Advance Access originally published online on March 17, 2007
Annals of Oncology 2007 18(6):1015-1020; doi:10.1093/annonc/mdm076
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© 2007 European Society for Medical Oncology

breast cancer

A phase II study of dose-dense epirubicin plus cyclophosphamide followed by docetaxel plus capecitabine and pegfilgrastim support as preoperative therapy for patients with stage II, IIIA breast cancer

C Natoli1, E Cianchetti2, N Tinari1, D Angelucci1, A Grassadonia1, M Zilli1, C Ficorella3, E Ricevuto3, S Grossi2, M De Tursi1, C Carella1, AI Rispoli3 and S Iacobelli1,*

1 Department of Oncology and Neurosciences and Foundation, University "G. D'Annunzio", Chieti-Pescara
2 Department of Surgery, University "G. D'Annunzio", Chieti-Pescara
3 Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy

* Correspondence to: Dr S. Iacobelli, Department of Oncology and Neurosciences, Foundation University "G. D'Annunzio", Via dei Vestini, 5-66100 Chieti, Italy. Phone: +39 08713556732; Fax: +39 08713556707; E-mail: iacobell{at}unich.it

Background: This phase II study was conducted to evaluate tumor response rate and safety profile of dose-dense epirubicin plus cyclophosphamide followed by docetaxel plus capecitabine given preoperatively to patients with stage II or IIIA breast cancer.

Patients and methods: Patients underwent four cycles of dose-dense cyclophosphamide 600 mg/m2 and epirubicin 90 mg/m2 every 2 weeks followed by two cycles of docetaxel 36 mg/m2 on days 1, 8, and 15 plus capecitabine 1250 mg/m2 on days 5–18 every 4 weeks, with prophylactic pegfilgrastim. The primary objective of the study was to determine the incidence of pathologic complete response defined as the absence of invasive or in situ cancer in the breast and the axillary nodes at definitive surgery.

Results: Forty-four patients were enrolled in the study and 41 (93%) were assessable for response to chemotherapy. An objective clinical response was observed in 38 (93%) patients. Seven patients (17.1%) exhibited a pathologic complete response. Breast-conserving surgery was carried out in 36 (88%) patients. Grade 3/4 neutropenia occurred in 4.3% of 252 administered chemotherapy cycles. No febrile neutropenia, cardiac toxicity, thrombocytopenia or other serious adverse event was registered.

Conclusion: The sequential combination of dose-dense epirubicin plus cyclophosphamide followed by docetaxel plus capecitabine is an effective and well-tolerated neo-adjuvant chemotherapy for stage II, IIIA breast cancer.

Key words: breast cancer, dose-dense chemotherapy, pathologic complete response, preoperative chemotherapy

Received for publication November 6, 2006. Revision received February 1, 2007. Accepted for publication February 2, 2007.


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