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
leucovorin...... 10 mg/sqm orally every 6 hours times 6
beginning 24 hours after methotrexate.
FREQUENCY....... Repeat regimen every 6 weeks.
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.
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.