To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: DG DISPATCH - BREAST CANCER: Neoadjuvant Therapy With Taxotere Improves Efficacy URL: http://www.pslgroup.com/dg/14FC72.htm Doctor's Guide December 10, 1999
By Robert Carlson Special to DG News
SAN ANTONIO, TX -- December 10, 1999 -- The anticancer drug Taxotere (docetaxel) enhances the effects of a conventional chemotherapy regimen in women with large tumors or with locally advanced breast cancer, according to researchers from Scotland.
Prof. Oleg Eremin, from Grampian University Hospital, in Aberdeen, Scotland, presented data at the 22nd Annual San Antonio Breast Cancer Symposium on the use of docetaxel, added to a regimen of cyclophosphamide, vincristine and prednisone before surgery. The strategy of giving chemotherapy before surgery is known as neoadjuvant therapy. The goal is not only to kill tumor cells, but also to shrink the tumor and make it easier for surgeons to remove every bit of it.
Women with locally advanced breast cancer typically have a poor prognosis, Dr. Eremin said. In addition, the larger a tumor is, the more likely it has spread to the lymph nodes and to other parts of the body.
Dr. Eremin's report was based on experience with 150 women, none of whom had received treatment before this study. They had tumors 3 cm or larger in size or tumors that had spread to lymph nodes in the armpit.
Treatment began with a standard chemotherapy regimen known as CVAP, which includes 1000 mg/m2 of cyclophosphamide, 50 mg/m2 of vincristine, and 40 mg/m2 of prednisone. One treatment cycle consisted of CVAP on each of five days. Cycles were repeated every three weeks, for four cycles.
Women who did not respond to the first four cycles of CVAP were switched to docetaxel, 100 mg/m2 given once every three weeks for 12 weeks.
The 101 women who did respond to the initial CVAP therapy were assigned to one of two groups: to receive four additional cycles of CVAP, or to receive docetaxel at 100 mg/m2 every three weeks for 12 weeks.
Surgery took place four to six weeks after the end of chemotherapy -- either mastectomy or breast-conserving "lumpectomy" with concomitant radiation.
For those women whose disease had improved or did not progress, therapy finished off with five years of the hormonal agent tamoxifen.
Results of the Study
The response rate for the 49 women who received four cycles of CVAP and then four cycles of docetaxel was 94 percent, Dr. Eremin reported, which compared very favorably to the 67 percent response rate among the 52 women who were randomized to continue on standard therapy alone.
The response rate for the 49 women not randomized in the trial, who received docetaxel after not responding to CVAP, was 47 percent.
"Because there is presently no consensus on the standard chemotherapy for patients with either locally advanced breast cancer or large primary tumors, it is extremely important to define the role of new agents, such as docetaxel, that have shown high activity," Dr. Eremin said. "Our results suggest that docetaxel should be strongly considered in the management of patients receiving neoadjuvant chemotherapy for breast cancers."
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