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Breast Cancer
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my personal edition > breast cancer > news
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DGDispatch
Sonogram Results Can Help Direct Additional Treatment in Women With Breast Cancer: Presented at SABCS
By Emma Hitt, PhD
SAN ANTONIO, TX -- December 19, 2006 -- Sonography can be used to evaluate initial response to 2 rounds of chemotherapy in women with breast cancer, and the results can be used to help select therapy, avoid further unnecessary treatment, and minimize toxicity, according to new study from the German Breast Group.
Assessment of chemosensitivity after 2 cycles of neoadjuvant chemotherapy with docetaxel 75 mg/m2, doxorubicin 50 mg/m2, and cyclophosphamide 500 mg/m2 (TAC) can help predict the benefits of additional chemotherapy, said Gunter von Minckwitz, MD, PhD, with the German Breast Group, and the University Women's Clinic, Frankfurt, Germany.
The findings of a prospective study of this strategy were presented on December 17th at the 29th Annual San Antonio Breast Cancer Symposium (SABCS).
The study included 2,106 women with operable tumors, measuring at least 2 cm, or locally advanced, nonmetastatic breast cancer. The women were treated with 2 cycles of TAC. The researchers then used ultrasound to determine whether the tumor size had shrunk by less than 50%. Women with this response were classified as being "low chemosensitive." About 30% of women fell in this category. By contrast, the remaining 70% showed a 50% or greater decrease in tumor size on ultrasound and were classified as "high chemosensitive."
The 627 low chemosensitive women went on to receive an additional 4 cycles of TAC or 4 cycles of vinorelbine/capecitabine while the 1,390 highly chemosensitive women were further randomized to receive 4 or 6 cycles of TAC.
The low chemosensitive women were more likely to have locally advanced (P < .001), grade 1/2 disease, P < .0001) and hormone receptor-positive disease (P < .0001), the researchers note.
Of the highly chemosensitive women, 46.6% had a complete response as measured by palpation compared with 14.1% of the low chemosensitive group. Ultrasound detected a complete response rate of 10.1% and 31.7% for the low and high chemosensitive groups, respectively, and 5.6% and 25.2% achieved a pathological complete response.
According to the researchers, hormone receptor positivity and tumor grade were independent predictors of pathologic complete response.
Dr. Von Minckwitz pointed out that locally advanced and inflammatory breast cancer showed similar responses "and do not need separate trials of neoadjuvant therapy."
They also found that vinorelbine/capecitabine and TAC achieved comparable sonographic responses in the low chemosensitive women (63.5% with vinorelbine/capecitabine compared with 59.9% with TAC), but the toxicity profile was more acceptable with vinorelbine/capecitabine.
In the high chemosensitive women, 6 cycles of TAC achieved a similar pathologic complete response as 4 cycles (26.9% vs 23.6%), but additional toxicity was observed with 6 cycles of TAC.
[Presentation title: Individualized Treatment Strategies According to in Vivo-Chemosensitivity Assessed By Response After 2 Cycles of Neoadjuvant Chemotherapy. Final Results of the GeparTrio Study of German Breast Group. Abstract 42]
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