New option for locally advanced breast cancer?

Abstract

Patients with locally advanced breast cancer (LABC) could benefi t from a neoadjuvant epirubicin, cisplatin, and capeci tabine (EXC) regimen, according to a new study (Eur J Cancer 2007; 43: 1153–60). “We evaluated the clinical effi cacy... of...capecitabine and...cisplatin, which is seldom used in breast cancer treatment, together with epirubicin, a standard drug in breast cancer”, says lead author Kenneth Villman (Department of Oncology, Ore bro University Hospital, Orebro, Sweden). A total of 48 women with LABC were included in this phase II study that was carried out at ten Oncology Departments in Sweden. The patients received EXC in 3-week cycles for 9 weeks, and then under went modifi ed radical maste ctomy. Post opera tively, two more cycles of EXC were given. Postoper ative radiotherapy was ad mini stered according to local guidelines. All patients with hormonereceptor-positive breast cancer received tamoxifen for 5 years. The researchers also assessed the role of several biomarkers (ERBB2, topoisomerase IIα, thymidine phosphorylase, thymidylate synthase, and dihydropyrimidine dehydrogenase) in these patients. However, none of these markers predicted response in this group of patients. 46 patients completed at least two cycles of chemotherapy, with a response rate of 74% (95% CI 59–86), including complete responses in 13% (5–26%). Five patients of those treated with EXC could not undergo surgery and, instead, were given radiotherapy or another type of chemotherapy; therefore, these patients were not evaluable for histopathological response. With nine patients showing pathological complete response (pCR), pCR was 19% (9–33%) in the intentionto-treat group and 22% (11–38%) in the EXC-treated group that underwent surgery. During a median follow-up of 35 months’ disease recurrence occurred in nine patients. Only one patient with pCR showed recurrence (p=0·39). Treatment-related haematological toxic eff ects were manageable. However, nausea, vomiting and coagulation disorders were problematic and prompted discontinuation of treatment in six patients. “The EXC combination [could] be a valid alternative in this diffi cult-totreat group...if [these] results [are] validated in large future studies”, says Judith Hurley (Sylvester Cancer Center, University of Miami, FL, USA). The high frequency of coagulation disorders is striking and must be carefully monitored in future studies with this drug combination, she cautions.