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Annals of Oncology Advance Access published online on August 9, 2005
Annals of Oncology, doi:10.1093/annonc/mdi360
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© 2005 European Society for Medical Oncology
Received January 31, 2005
Revised June 27, 2005
Accepted June 28, 2005

Original article

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

Y. W. Moon 1, S. Y. Rha 2, H. C. Jeung 1, W. I. Yang 3, C. O. Suh 4, and H. C. Chung 2*

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

* To whom correspondence should be addressed.
H. C. Chung, E-mail: unchang8{at}yumc.yonsei.ac.kr


  Abstract

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.

Keywords: adriamycin; cyclophosphamide; infusional 5-fluorouracil; locally advanced breast cancer; neoadjuvant chemotherapy.
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