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Breast Cancer
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my personal edition > breast cancer > news
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DGDispatch
Inflammatory Breast Cancer Responds to Platinum-docetaxel Regimen: Presented at SABCS
By Robert H. Carlson
SAN ANTONIO, TX -- December 5, 2003 -- The final report of three sequential studies shows that locally advanced and inflammatory breast cancer responds to a platinum-docetaxel regimen in the neoadjuvant therapy setting.
"Taxotere and platinum analogs have excellent survival data in patients with poor prognosis breast cancer," said principal investigator Judith Hurley, MD, associate professor of clinical medicine, University of Miami, Florida, United States. The survival rate for the 57 women taking the combination for 4 years is 65%.
Dr. Hurley described the results with this regimen in women with tumors larger than 5 cm in diameter here on December 4th at the 26th Annual San Antonio Breast Cancer Symposium.
"Platinum analogs have never become popular in breast cancer therapy," Dr. Hurley said. "Perhaps because of the plenitude of other efficacious and easier-to-use agents, platinum has not been incorporated into the curative setting of breast cancer."
Cisplatin had been used at the University of Miami in the curative setting as part of a neoadjuvant regimen since 1991, however, said Dr. Hurley, because it does have a high rate of response in previously untreated breast cancer.
Dr. Hurley reported on the final results of three sequential trials at her institution using platinum analogues in combination with docetaxel.
The original regimen tested included cisplatin and docetaxel every 3 weeks for 4 cycles, plus granulocyte colony-stimulating factor (G-CSF). Patients then underwent surgery followed by 4 cycles of doxorubicin and cyclophosphamide, radiation therapy, and finally tamoxifen for 5 years.
"Based on the synergy between trastuzumab, docetaxel and cisplatin in the pre-clinical setting, trastuzumab was added to docetaxel/cisplatin for tumors that overexpressed human epidermal growth factor receptor 2 [HER-2] in 1999," Dr. Hurley said.
That second regimen gave cisplatin and docetaxel every 3 weeks for 4 cycles, plus trastuzumab, plus G-CSF and epoetin for white- and red-blood-cell support. Patients then underwent surgery followed by doxorubicin and cyclophosphamide for 4 cycles, in addition to radiotherapy and 5 years of tamoxifen.
To explore the possibility that weekly therapy might maintain response rate while decreasing toxicity, a third combination of weekly carboplatin and docetaxel was developed, given weekly for 3 cycles and then monthly for 4 cycles. Surgery followed, then 4 cycles of doxorubicin-cyclophosphamide, radiotherapy and finally tamoxifen for 5 years.
Dr. Hurley reported that 4-year overall survival rate for the 57 women in the first regimen is 65%, "which in this group of patients is really good," she said. The 3-year overall survival rate for the 48 women on the second regimen now is 84%. And the 2-year survival rate for the 44 women taking the third regimen is currently 72%.
For all 149 women in the three trials, the pathological complete response rate has been 23%, Dr. Hurley said.
[Study Title: Platinum Salts and Docetaxel as Primary Therapy of Locally Advanced and Inflammatory Breast Cancer: the Final Report of Three Sequential Studies. Abstract 238]
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