Combining ovarian function suppression (GNRH analog) and chemotherapy with epirubicin (E) cisplatin (C) and fluorouracil as continuous infusion (FUci) (ECF regimen) as primary treatment for premenopausal women with endocrine responsive breast cancer

Abstract

9645 Background: Chemotherapy is an established primary treatment for patients with large breast cancer. Although premenopausal patients with endocrine responsive tumors might benefit from the addition of ovarian suppression to chemotherapy, no data are available on their combined use. Methods: We investigated the efficacy in terms of clinical response (CR) and pathological complete responses (pCR) of the ECF regimen (E 25 mg/m2 i.v. Day 1&2; P 60 mg/ m2 i.v. Day 1; CIfu 200 mg/ m2 Days 1 through 21, all q 21 days) for 6 courses, in association with a 28-day GnRH analogue, administered either as a subcutaneous or intramuscular injection from start of chemotherapy in premenopausal women with T2-T4a-d N0–2 M0 ER and/or PgR positive breast cancer, all treated in one institution. FSH, LH and 17-β-estradiol were measured every 21 days starting from day 1 of chemotherapy. Results: Thirty-six patients were enrolled from 09/1999 to 12/2001. Median age was 40 years (range 26–52). Chemotherapy was administered for at least 3 courses in all patients (range 3–6). Thirty out of 31 patients evaluable for endocrine assessment had documented ovarian suppression after administration of a GnRH analogue. Median time to ovarian suppression was 28 days (range 20–43). Clinical response (complete or partial) was observed in 27 out of 36 patients (75%) and a pCR was observed in 4 pts (11 %). Nine (25%) patients had stable disease and no progression was observed. Twenty-one patients were submitted to quadrantectomy + axillary node dissection and 15 had a radical mastectomy. Conclusions: The combination of ECF and a GnRH analogue is associated with a high response rate. Results favorably compare with previous series of patients with endocrine responsive disease treated with chemotherapy alone, where no pCRs were observed. The concurrent combination of chemotherapy and GnRH analog dose not seem similar to concurrent tamoxifen and chemotherapy, for which evidence of a detriment on efficacy is documented, and appears suitable for further investigations. No significant financial relationships to disclose.