Combined sequential approach in locally advanced breast cancer

Zambetti, Milvia; Oriana, Saro; Quattrone, Pasquale; Verderio, Paolo; Terenziani, Monica; Zucali, R; Valagussa, Pinuccia; Bonadonna, Gianni

doi:10.1023/a:1008345901178

Cited by 21 publications

(8 citation statements)

References 20 publications

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“…In published studies, approximately 23%-32% of patients for whom the initial surgery would be a mastectomy are able to undergo BCT following PST [3][4][5][6]85]. In the NSABP B-18 trial, 67% of patients underwent BCT after neoadjuvant chemotherapy, compared with 60% of the group that received postoperative adjuvant treatment [3][4][5].…”

Section: Challenges Of Rt After Pst Bct After Pst In Locally Advancedmentioning

confidence: 99%

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Primary Systemic Therapy of Breast Cancer

et al. 2006

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Primary systemic therapy (PST) or neoadjuvant therapy is used in nonmetastatic breast cancer to treat systemic disease earlier, decrease tumor bulk ideally to a complete pathological response (pCR), and reduce the extent of surgery. The multitude of clinical trials using PST in breast cancer patients has not proven the fundamental hypotheses of improved overall survival and disease-free survival that drove the investigation of PST. The other potential advantages of PST, which include increasing the rate of breast-conserving surgery and predicting outcome to a particular chemotherapy regimen, are also not conclusively established. We examined the published literature on PST for breast cancer and predominantly focused our review on data from large, randomized clinical trials comparing primary systemic chemotherapy with adjuvant chemotherapy, different primary systemic chemotherapy regimens, primary systemic chemotherapy with hormonal therapy, and different preoperative hormonal therapies. Although the optimal neoadjuvant chemotherapy regimen has not been established, a combination of four cycles of an anthracycline followed by four cycles of a taxane appears to produce the highest pCR rate (22%-31%). In patients with HER-2-positive breast cancer, concurrent use of neoadjuvant trastuzumab with an anthracycline-taxane combination has produced provocative results that require further confirmatory studies. Preoperative hormonal therapy is associated with low pCR rates and should be reserved for patients who are poor candidates for systemic chemotherapy. The optimal management of patients with residual disease after the administration of maximum neoadjuvant therapy remains to be defined. The surgical approach, including the role of sentinel node biopsy and delivery of radiation therapy after PST in breast cancer patients, is evolving. Ongoing clinical trials will help identify the subset of patients who would most benefit from the use of PST, establish the most effective PST regimen, and determine the optimal multidisciplinary approach in the management of breast cancer. The Oncologist 2006;11:574-589 Learning ObjectivesAfter completing this course, the reader will be able to:1. Describe the rationale for using primary systemic therapy (PST) in the treatment of nonmetastatic breast cancer.2. Discuss the pathologic complete response (pCR) rate as a surrogate marker of PST benefit.3. Select the most appropriate regimen for a patient with breast cancer considered for PST.4. Explain the role of sentinel node biopsy and delivery of radiation therapy after PST in breast cancer patients.Access and take the CME test online and receive 1 AMA PRA category 1 credit at CME.TheOncologist.com CME CME This material is protected by U.S.

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Section: Challenges Of Rt After Pst Bct After Pst In Locally Advancedmentioning

confidence: 99%

“…With short follow-up, recurrence rates of 5% or less are observed. However, studies with follow-up of 52 months, 85.5 months, and 124 months reported recurrence rates of 14%, 19%, and 23%, respectively [9, 85,88].…”

Section: Challenges Of Rt After Pst Bct After Pst In Locally Advancedmentioning

confidence: 99%

Primary Systemic Therapy of Breast Cancer

et al. 2006

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“…In a retrospective analysis of 100 patients, Victor et al (1999) correlated the presence of IBC and four or more involved axillary nodes with poorer outcome. Their conclusions were supported by Gardin et al (1995) in an analysis of 125 patients, and by others as well (Sanchez-Forgach et al, 1992;Kuerer et al, 1998;Zambetti et al, 1999). The clinical size of the primary tumour (Valagussa et al, 1990;Fein et al, 1994) as well as the clinical nodal status (Valagussa et al, 1990) were also found to correlate with outcome.…”

Section: Discussionmentioning

confidence: 76%

Prediction of outcome in locally advanced breast cancer by post-chemotherapy nodal status and baseline serum tumour markers

et al. 2002

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In spite of the apparent improvement in outcome in locally advanced breast cancer, the prognosis remains dismal in many patients. The aim of this study was to define prognostic subgroups within this heterogeneous entity. Between 1990 and 1999, 104 consecutive patients with locally advanced breast cancer were treated by a multimodality programme consisting of 4 -6 courses of CAF induction chemotherapy followed by surgery, breast-conserving when feasible. In most cases, chemotherapy was then resumed, up to a total of eight courses, followed by locoregional radiation therapy. Patients with hormone receptorpositive tumours received tamoxifen (20 mg day 71 ) for 5 years. At a median follow-up of 57 months, the 5-year overall survival for the entire group and the disease-free survival for the 94 operated patients were 65% and 53%, respectively. Univariate analysis identified 10 prognostic factors of overall and disease-free survival, of which four retained significance on multivariate analysis: inflammatory breast cancer (P=0.0000, P=0.0004, respectively), baseline tumour markers (P=0.003 for both), post-chemotherapy number of involved nodes (P=0.003; P=0.017) and extracapsular spread (P=0.052; P=0.014). In conclusion, besides inflammatory features, baseline tumour markers and post-chemotherapy nodal status are strong predictors of outcome in locally advanced breast cancer.

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“…New data and the newest treatments available indicate the need to re-think our general approach to endocrine therapy and endocrine prevention (Howell et al 2001). This is of particular interest today because the results of new combined therapies, including chemotherapy, endocrine therapy and radiotherapy modalities, have also been reported (Crump et al 1997, Brain et al 1999, Zambetti et al 1999, Tan et al 2001, Vicini et al 2001.…”

Section: Mechanism and Tolerability Of Hormone Therapies In Breast Camentioning

confidence: 99%

Interactions between radiotherapy and endocrine therapy in breast cancer.

Moral

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N√∫√±ez³

et al. 2002

Endocrine-Related Cancer

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Whenever radiation therapy is given with curative intent there is the risk of serious damage to normal tissue. This risk increases with the dose of radiation, as does the probability of local tumour control. In the attempt to cure, the doses reach a level that inevitably causes some undesirable adverse effects, ranging from undetectable, or minimal, to unacceptably severe. Over the last few years, a number of reports have suggested that the prediction of normal tissue response after radiotherapy may be achieved by assays on samples withdrawn from the patients prior to treatment, although recent reports have described mixed results. The ability to predict tumour response to anti-hormones in patients with breast cancer has important implications with regard to treatment. Recent discoveries promise to provide individualized treatment options. However, there are no data to support that, used jointly, the combination of radiotherapy and hormone therapy may achieve an enhancement of breast cancer tumour response. Nowadays, development in cancer therapy is increasingly arising out of studies in basic science; its implementation in the hands of clinicians is improving the management of patients with cancer. In addition, as the biological aspects of irradiation and hormonal therapy offer an explanation, at least in part, for the outcome observed in patients with breast cancer after therapy, we have focused this review on trying to analyse the most relevant experimental research about the relative roles of radiotherapy and hormonal therapy, the corresponding side-effects and, taking into account recent advances, future areas of research that we consider of major importance in the field.

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Combined sequential approach in locally advanced breast cancer

Cited by 21 publications

References 20 publications

Primary Systemic Therapy of Breast Cancer

Primary Systemic Therapy of Breast Cancer

Prediction of outcome in locally advanced breast cancer by post-chemotherapy nodal status and baseline serum tumour markers

Interactions between radiotherapy and endocrine therapy in breast cancer.

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