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Annals of Oncology Advance Access published online on June 30, 2005
Annals of Oncology, doi:10.1093/annonc/mdi308
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© 2005 European Society for Medical Oncology
Received January 16, 2005
Revised March 9, 2005
Accepted May 10, 2005

Original article

Dose-finding study of weekly docetaxel, anthracyclines plus fluoropyrimidines as first-line treatment in advanced breast cancer

O. Pagani 1*, C. Sessa 1, F. Nolè 2, E. Munzone 2, D. Crivellari 3, D. Lombardi 3, B. Thürlimann 4, D. Hess 4, R. Graffeo 1, M. Ruggeri 1, S. Longhi 1, and A. Goldhirsch 5

1 Institute of Oncology of Southern Switzerland (IOSI), Ospedale S. Giovanni, Bellinzona, Switzerland
2 Divisions of Medical Oncology, and Clinical Hemato-Oncology, Department of Medicine, European Institute of Oncology, Milan
3 Divisione di Oncologia Medica C, Istituto Nazionale Tumori, Aviano, Italy
4 Medizinische Klinik C, Kantonspital, St Gallen, Switzerland
5 Institute of Oncology of Southern Switzerland (IOSI), Ospedale S. Giovanni, Bellinzona, Switzerland; Divisions of Medical Oncology, and Clinical Hemato-Oncology, Department of Medicine, European Institute of Oncology, Milan

* To whom correspondence should be addressed.
O. Pagani, E-mail: opagani{at}siak.ch


  Abstract

Background: The efficacy and safety of prolonged fluoropyrimidines, either intravenously or orally, prompted their integration with taxanes and anthracyclines in the treatment of advanced breast cancer (ABC). We conducted three subsequent dose-finding studies on first-line chemotherapy in ABC with anthracyclines, either epirubicin (E) or doxorubicin (A), and docetaxel (T), both given on days 1 and 8 every 3 weeks, plus continuous infusion (CI) 5-fluorouracil (F) or capecitabine (X).

Patients and methods: Sixty-two patients (37% dominant visceral disease, 48% locally advanced disease, 45% two or more sites involved), received different doses of T (60-80 mg/m2), A (40-50 mg/m2) or E (60-90 mg/m2) and X (1650 and 2000 mg/m2), or CI F at a fixed daily dose of 200 mg/m2. Cardiac function was monitored at baseline and then every four cycles by echocardiography.

Results: The median number of cycles per patient with all regimens was four (range one to eight). Haematological and gastrointestinal toxicity defined the maximum tolerated doses, at T80/E90 mg/m2 with TEF, T70/A50/X2000 mg/m2 with TAX and T70/E80/X1650 mg/m2 with TEX. Two patients treated with TEF developed transient cardiac toxicity (dilatative cardiomyopathy and coronary subtotal stenosis requiring stenting) after cumulative E doses of 400 mg and 1100 mg/m2, respectively. Fifty-nine patients were evaluable for response; the overall response rates (ORR) were comparable between regimens (54% with TEF, 71% with TAX and 86% with TEX), with an 81% ORR in 31 patients with locally advanced disease.

Conclusions: The addition of fluoropyrimidines to weekly, intermittent ET is well tolerated and active in ABC.

Keywords: advanced breast cancer; anthracyclines; docetaxel; fluoropyrimidines.
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