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Preoperative Chemotherapy Extends Breast Conservation Surgery, Expedites Finding Most Effective Agents for Patients' Cancer Types: Presented at EBCC

By Paula Moyer

HAMBURG, GERMANY -- March 22, 2004 -- Preoperative chemotherapy makes breast conservation surgery feasible for more breast cancer tumours and also helps physicians identify the most appropriate chemotherapeutic agents for an individual woman's disease, according to findings presented here March 17^th at the 4^th European Breast Cancer Conference.

"Preoperative chemotherapy is the newest development in treating breast cancer," said investigator Michael Untch. Dr. Untch is the head of breast cancer services at the University of Munich-Grosshadern in Munich, Germany, where he is an assistant professor of gynaecology and obstetrics. He summarised a recent study's findings and pointed to ongoing studies designed to assess the value of preoperative chemotherapy, also called neoadjuvant chemotherapy.

Prior usage of neoadjuvant chemotherapy was in the treatment of inoperable and inflammatory breast cancer, a practice that caused investigators to note a survival equivalence between preoperative and postoperative chemotherapy, as well as a strong correlation of disease-free and overall survival with pathological complete remission. Other investigators have used several chemotherapy regimens in order to achieve higher rates of pathological complete remission, Dr. Untch said, noting that these have included taxanes, as well as modifications of dose, number of cycles, and density of treatment.

The current research evaluated the use of dose density and dose intensity treatment consisting of paclitaxel and epirubicin in 678 patients who either had tumours with a median diameter of 4 cm or inflammatory disease. The dose-dense regimen consisted of 12 weekly cycles of paclitaxel followed by 4 cycles of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) every 3 weeks The investigators documented higher rates of measurable response, pathological complete remission, and negative axillary lymph nodes at the time of surgery in patients treated with the dose-dense regimen than with the standard combination of paclitaxel and epirubicin. Patients treated with dose-dense chemotherapy were also more likely to be able to undergo breast-conserving surgery.

Dr. Untch noted that several ongoing trials are looking at dose-dense preoperative chemotherapy. In one trial, which uses a combination of epirubicin, paclitaxel, and anastrazole, the investigators are comparing 24-week courses of dose-dense and standard treatment, with or without darbepoetin alpha. In another phase 2 trial, investigators are using a combination of paclitaxel, epirubicin, and cyclophosphamide preoperatively, as well as a second preoperative course of paclitaxel and herceptin, followed by herceptin monotherapy for 9 months after surgery.

Dr. Untch noted that preoperative chemotherapy can increase the number of women eligible for breast-conserving surgery by 15% to 30% and that such patients are not at increased risk of ipsilateral tumour recurrence. The practice also allows for an expedited identification of predictive markers such as gene profiles, he said, and an earlier tailoring of chemotherapy, since the treating physician can evaluate the patient's response to treatment within 6 months after the breast cancer diagnosis.


[Study title: Towards optimisation of chemotherapy. Abstract 24]

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