Inclusion of taxanes, particularly weekly paclitaxel, in preoperative chemotherapy improves pathologic complete response rate in estrogen receptor-positive breast cancers.

Abstract

BACKGROUND:

We examined if inclusion of a taxane and more prolonged preoperative chemotherapy improves pathologic complete response (pCR) rate in estrogen receptor (ER)-positive breast cancer compared with three to four courses of 5-fluorouracil, doxorubicin, cyclophosphamide (FAC).

PATIENTS AND METHODS:

Pooled analysis of results from seven consecutive neo-adjuvant chemotherapy trials including 1079 patients was carried out. These studies were conducted at MD Anderson Cancer Center from 1974 to 2001. Four hundred and twenty-six (39.5%) patients received taxane-based neo-adjuvant therapy. pCR rates and survival times were analyzed as a function of chemotherapy regimen and ER status. Multivariate logistic and Cox regression analysis were carried out to identify variables associated with pCR and survival.

RESULTS:

Patients with ER-negative cancer had higher overall pCR rate than patients with ER-positive tumors (20.1% versus 4.9%, P < 0.001). In ER-negative patients, the pCR rates were 29% and 15% with and without a taxane (P < 0.001). In ER-positive patients, the pCR rates were 8.8% and 2.0% with and without a taxane (P < 0.001). In multivariate analysis, clinical tumor size (P < 0.001), ER-negative status (P < 0.001) and inclusion of a taxane (P = 0.01) were independently associated with pCR. For patients with pCR, survival was similar regardless of ER status or the type of regimen that induced pCR.

CONCLUSION:

pCR rates increased for patients with both ER-positive and ER-negative tumors as regimens started to include a taxane and became longer. This indicates that a subset of patients with ER-positive breast cancer benefits from more aggressive chemotherapy, similarly to patients with ER-negative tumors.

• Authors: C Mazouni, S-W Kau, D Frye, F Andre, H M Kuerer, T A Buchholz, W F Symmans, K Anderson, K R Hess, A M Gonzalez-Angulo, G N Hortobagyi, A U Buzdar, L Pusztai
• Journal: Annals of oncology : official journal of the European Society for Medical Oncology (Ann Oncol) Vol. 18 Issue 5 Pg. 874-80 (May 2007) ISSN: 0923-7534 [Print] England
• PMID: 17293601 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Meta-Analysis, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Bridged-Ring Compounds
• Receptors, Estrogen
• Taxoids
• taxane
• Doxorubicin
• Cyclophosphamide
• Paclitaxel
• Fluorouracil

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Breast Neoplasms (classification, drug therapy, metabolism, pathology)
• Bridged-Ring Compounds
• Chemotherapy, Adjuvant
• Cyclophosphamide (therapeutic use)
• Doxorubicin (therapeutic use)
• Drug Administration Schedule
• Female
• Fluorouracil (therapeutic use)
• Humans
• Middle Aged
• Neoplasms, Hormone-Dependent (drug therapy, surgery)
• Paclitaxel (administration & dosage, analogs & derivatives)
• Prognosis
• Receptors, Estrogen (metabolism)
• Survival Analysis
• Taxoids
• Tumor Burden (drug effects)