LOC.ADV.ADJ.                                           breast(33)
 _________________________________________________________________
  cytoxan......... 500 mg/sqm IV day 1.
  adriamycin...... 30 mg/sqm IV day 1.
  methotrexate.... 300 mg/sqm IV day 8.
  fluorouracil.... 500 mg/sqm IV day 8.
  tamoxifen....... 40 mg/sqm orally days 2 to 6.
  premarin........ 0.625 mg orally every 12 hours times 3 on day 
                   7.
  leucovorin...... 10 mg/sqm orally every 6 hours times 6 
                   beginning 24 hours after methotrexate.
  FREQUENCY....... Repeat regimen every 6 weeks.


  reference...
    Swain SM.  Sorace RA.  Bagley CS.  Danforth DN Jr.  Bader J.  
    Wesley MN. Steinberg SM.  Lippman ME. Neoadjuvant chemotherapy 
    in the combined modality approach of locally advanced 
    nonmetastatic breast cancer. Cancer Research.  47(14):3889-94, 
    1987 Jul 15. 
  abstract...
    We have treated 76 patients with locally advanced breast 
    cancer, 31 with stage IIIA, 41 with stage IIIB, and 4 with 
    stage IV disease, with primary induction chemotherapy 
    including an attempted hormonal synchronization in 70 
    patients. All were treated to maximum objective clinical 
    response before proceeding to any local therapy. Patients 
    achieving a complete response with a negative repeat biopsy 
    generally received radiation therapy while patients with 
    residual disease, partial response (PR) or no change (NC) 
    status received debulking surgery prior to radiation therapy. 
    Regardless of response to induction chemotherapy, patients 
    received at least 6 additional months of chemotherapy 
    following local therapy. Initial doses of combination 
    chemotherapy were escalated to targeted myelosuppression. The 
    objective response rate to induction chemotherapy was 93% with 
    49% complete response (CR), 44% PR, and 7% NC. The median 
    numbers of cycles of chemotherapy to achieve a CR, PR, or NC 
    were 5, 3, and 5, respectively. Three patients who currently 
    have PRs are still on chemotherapy with continued tumor 
    regression. Of 37 patients achieving a CR to chemotherapy, 35 
    were assessed by biopsies to determine pathological evidence 
    of response. Twenty-three of the 37 patients (62%) were proven 
    to be complete responders with negative biopsies. Twenty-four 
    patients have relapsed, 6 with stage IIIA, 16 with stage IIIB, 
    and 2 with stage IV. Five patients have had locoregional 
    relapses alone, 4 locoregional and distant, and 15 distant 
    alone. Median time to progression is 35.9 months for stage 
    IIIA and 34.2 months for stage IIIB. Median survival is 35.3 
    months for stage IIIB and is indeterminate for stage IIIA. 
    This aggressive primary chemotherapy regimen with hormonal 
    synchronization followed by local therapy appears to provide 
    excellent local control and encouraging early results on 
    systemic disease control.