Preoperative Chemotherapy in Primary Operable Breast Cancer: Results From the European Organization for Research and Treatment of Cancer Trial 10902
Tóm tắt
PURPOSE: To evaluate whether preoperative neoadjuvant chemotherapy in patients with primary operable breast cancer results in better overall survival (OS) and relapse-free survival rates and whether preoperative chemotherapy permits more breast-conserving surgery procedures than postoperative chemotherapy.
PATIENTS AND METHODS: Six hundred ninety-eight breast cancer patients (T1c, T2, T3, T4b, N0 to 1, and M0) were enrolled onto a randomized phase III trial that compared four cycles of fluorouracil, epirubicin, and cyclophosphamide administered preoperatively versus the same regimen administered postoperatively (the first cycle administered within 36 hours after surgery). Patients were followed up for OS, progression-free survival (PFS), and locoregional recurrence (LRR).
RESULTS: At a median follow-up of 56 months, there was no significant difference in terms of OS (hazards ratio, 1.16; P = .38), PFS (hazards ratio, 1.15; P = .27), and time to LRR (hazards ratio, 1.13; P = .61). Fifty-seven patients (23%) were downstaged by the preoperative chemotherapy, whereas 14 patients (18%) underwent mastectomy and not the planned breast-conserving therapy.
CONCLUSION: The use of preoperative chemotherapy yields similar results in terms of PFS, OS, and locoregional control compared with conventional postoperative chemotherapy. In addition, preoperative chemotherapy enables more patients to be treated with breast-conserving surgery. Because preoperative chemotherapy does not improve disease outcome compared with postoperative chemotherapy, future trials should involve quality-of-life studies to investigate whether patients will benefit from this treatment modality.
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Gunduz N, Fisher B, Saffer E: Effect of surgical removal on the growth and kinetics of residual tumor. Cancer Res 39: 3861,1979-3865,
Fisher B, Gunduz N, Saffer E: Influence of the interval between primary tumor removal and chemotherapy on kinetics and growth metastases. Cancer Res 43: 1488,1983-1492,
Fisher B, Gunduz N, Coyle J, et al: Presence of a growth-stimulating factor in serum following primary tumor removal in mice. Cancer Res 49: 1996,1989-2001,
Fisher B, Saffer E, Rudock C, et al: Effect of local or systemic treatment prior to primary tumor removal on the production and response to a serum growth-stimulating factor in mice. Cancer Res 49: 2002,1989-2004,
Goldie JH, Coldman AJ: A mathematic model for relating the drug sensitivity of tumors to their spontaneous mutation rate. Cancer Treat Rep 63: 1727,1979-1733,
Ludwig Breast Cancer Study Group: Toxic effects of early adjuvant chemotherapy for breast cancer. Lancet 2: 542,1983-544,
Scholl SM, Fourquet A, Asselain B, et al: Neoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumors considered too large for breast conserving surgery: Preliminary results of a randomized trial—S6. Eur J Cancer 30A: 645,1994-652,
Scholl SM, Pierga JY, Asselain B, et al: Breast tumor response to primary chemotherapy predicts local and distant control as well as survival. Eur J Cancer 31A: 1969,1995-1975,
Gardin G, Rosso R, Campora E, et al: Locally advanced non-metastatic breast cancer: Analysis of prognostic factors in 125 patients homogeneously treated with a combined modality approach. Eur J Cancer 31A: 1428,1995-1433,
Belembaogo E, Feillel V, Chollet P, et al: Neoadjuvant chemotherapy in 126 operable breast cancers. Eur J Cancer 28A: 896,1992-900,
Herrada J, Iyer RB, Atkinson EN, et al: Relative value of physical examination, mammography, and breast sonography in evaluating the size of the primary tumor and regional lymph node metastases in women receiving neoadjuvant chemotherapy for locally advanced breast carcinoma. Clin Cancer Res 3: 1565,1997-1569,
Clahsen PC, van de Velde CJH, Duval C, et al: The utility of mitotic index, estrogen receptor and Ki-67 measurements in the creation of novel prognostic indices for node-negative breast cancer. Eur J Surg Cancer 2: 356,1999-363,
Poulsen B, Graversen HP, Beckmann J, et al: A comparative study of post-operative psychosocial function in women with primary operable breast cancer randomized to breast conservation therapy or mastectomy. Eur J Surg Cancer 23: 327,1997-334,