Oncology Medical News about high-risk primary breast cancer;chemotherapy

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Intensive dose-dense compared with conventionally scheduled preoperative chemotherapy for high-risk primary breast cancer
Journal of Clinical Oncology, 06/22/09

Untch M et al. – Phase III trial shows the efficacy and short-term safety of intense dose-dense (IDD) as preoperative chemotherapy. It was less well tolerated compared to standard treatment, but improved clinical outcomes in patients with noninflammatory high-risk primary breast cancer.

Methods

Aim was to compare preoperative IDD chemotherapy with conventionally scheduled preoperative chemotherapy in high-risk primary BCa
668 pts stratified for tumors ≥3 cm (n=567) or inflammatory BCa (n=101) randomly assigned to receive:
- Concurrent preoperative epirubicin/paclitaxel every 3 wks or
- Dose-dense and dose-escalated sequential epirubicin followed by paclitaxel every 2 wks
All patients received 3 cycles of cyclophosphamide, methotrexate, and fluorouracil chemotherapy after surgery

Results

IDD treatment improved pathologic complete response rate, disease-free survival, and overall survival vs epirubicin/paclitaxel
Pts with inflammatory BCa had a particularly poor prognosis and did not appear to benefit from IDD therapy in this trial
In contrast, pts with noninflammatory BCa benefited from IDD treatment
Treatment effects in multivariate analysis were for noninflammatory BCa, but not for all pts
IDD therapy was associated with more nonhematologic toxicities, anemia, and thrombocytopenia, but with similar neutropenia and infection rates

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