New Cytotoxic Drugs in Treatment of Breast Cancer

Mouridsen, Henning T.

doi:10.3109/02841869009090012

Cited by 22 publications

(10 citation statements)

References 27 publications

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“…Pre-operative chemotherapy (with or without hormonal therapy) is an integral part of treatment for patients with locally advanced breast carcinoma [1][2][3][4][5] . The aim of the pre-operative chemotherapy is to reduce the tumour burden and to prevent micro-metastasis.…”

Section: Introductionmentioning

confidence: 99%

The effects of chemotherapy on breast cancer tissue in locally advanced breast cancer

1996

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It is well known that chemotherapy induces cytomorphological changes in neoplastic and non-neoplastic tissue. Thirty-one stage III breast-carcinoma patients, treated with both pre-operative chemotherapy and mastectomy, were evaluated to define the effects of systemic chemotherapeutic agents in tumours, non-neoplastic breast tissue, and lymph nodes. Histological changes were compared with those observed in patients who had been treated by surgery alone. Cytoplasmic vacuolization was the most striking change in the tumour cells (59%). Chemotherapy was especially effective in the terminal duct lobular unit in non-neoplastic breast tissue. Lobular atrophy was observed in 20 (65%) cases, and lobular cellular atypia was seen in 16 (52%). The rate of ductal cellular atypia (42%) was not different from the control group. The most important changes seen in the non-neoplastic stromal component were fibrosis and hyalinization. These were found in 31 out of 727 evaluated lymph nodes. In serial sections, metastatic deposits were seen in or around these fibrotic or hyalinized areas. Chemotherapy is widely used in the treatment of early and locally advanced breast carcinomas. Familiarity with chemotherapy induced changes in breast tissue and lymph nodes have considerable importance in the accurate interpretation of these specimens.

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Section: Introductionmentioning

confidence: 99%

The effects of chemotherapy on breast cancer tissue in locally advanced breast cancer

1996

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“…At the time this study started, clinical experience suggested that doxorubicin 75 mg m-2 and epirubicin 90 mg m-would induce similar degrees of myelotoxicity (Rozencweig et al, 1984;Bonfante et al, 1982). In 1990, Mouridsen reviewed 10 years of clinical experience with epirubicin and calculated the equitoxic dose ratio for the haematological toxicity of doxorubicin and epirubicin to be 1:1.2 (Mouridsen et al, 1990). Drug dosages chosen in this study fulfilled this criterium.…”

Section: Discussionmentioning

confidence: 95%

Doxorubicin vs epirubicin, report of a second-line randomized phase II/III study in advanced breast cancer

et al. 1998

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Summary The EORTC Breast Cancer Cooperative Group carried out a randomized trial to compare doxorubicin with epirubicin as secondline chemotherapy in patients with metastatic breast cancer. Two hundred and fifty-nine patients with at least one site of metastatic disease entered this trial, of whom 232 patients were eligible. Treatment consisted of doxorubicin 75 mg m-2 or epirubicin 90 mg m-2 i.v. every 3 weeks. The overall response rates for doxorubicin and epirubicin were 36% and 28% respectively (P = 0.173). The median time to progression was 23 weeks for doxorubicin and 19 weeks for epirubicin (P = 0.063) and the median duration of response was 40 weeks for doxorubicin and 32 weeks for epirubicin (P = 0.059). The median survival was 47 weeks for doxorubicin and 44 weeks for epirubicin (P = 0.196). Leucocyte count on retreatment day (P = 0.011) and platelet nadir (P = 0.031) were significantly lower in the doxorubicin-treated group. Also mucositis (P < 0.001), diarrhoea (P = 0.005) and haemorrhage (P = 0.048) were significantly worse in the doxorubicin arm. Nine patients on doxorubicin and two patients on epirubicin experienced congestive heart failure (CHF). At the dose levels used in this study, no statistical differences in response rate and survival were found between the two treatment arms. Treatment with doxorubicin tended to result in a slightly longer duration of response and time to progression but doxorubicin was more toxic than epirubicin.

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“…The structural differences between the two anthracyclines account for the different safety profiles; larger doses of epirubicin are required to produce the same degree of toxicity as doxorubicin. The doxorubicin/epirubicin dose ratios for similar toxicities are 1:1.2 hematologic, 1:1.5 nonhematologic, and 1:1.8 for cardiac, while that for equal efficacy is 1:1 [1,9]. These properties of epirubicin have attracted clinical investigators to use this compound in a range of dosages and drug combinations to treat a variety of malignancies, such as those of breast, lung, bladder, head, and neck and lymphomas [1,5].…”

Section: Discussionmentioning

confidence: 99%

Randomized study comparing 4′‐epi‐doxorubicin (Epirubicin) versus doxorubicin as a part of induction treatment in adult acute lymphoblastic leukemia

et al. 2002

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Doxorubicin or daunorubicin are routinely used to induce remission in acute lymphoblastic leukemia (ALL). Efficacy of epirubicin (an analog of doxorubicin), however, has not been adequately evaluated in ALL management. This randomized study was undertaken to compare the relative efficacy of epirubicin vs. doxorubicin as part of induction chemotherapy in adult ALL. Between January 1990 and June 1998, 79 previously untreated adult ALL patients (age 11-55 years, median 20 years) were randomized to receive either doxorubicin (Group A, n = 39) or epirubicin (Group B, n = 40) as a part of induction therapy. Vincristine and prednisolone were common in each group. The induction treatment was followed by identical consolidation and maintenance therapy. The two groups were compared as regards pretherapy clinical and laboratory parameters, dose intensity of therapy, therapeutic efficacy, myelotoxicity, and survival. Epirubicin was as effective as doxorubicin in terms of complete remission rate (80% vs. 78.3%; P = 0.87) and relapse rate (57.1% vs. 51.7%; P = 0.68). Five-year overall survival (30% vs. 30%, P = 0.98) and disease-free survival (40% vs. 39%, P = 0.92) at median follow-up of 68 months was also similar in the two groups. The incidence of Grade 4 myelotoxicity was comparable in the two groups. Patients 20 years of age or less had better CR rates (90% vs. 65%; P = 0.011) and median overall survival (39 vs. 11 months; P = 0.008) compared to those who were older. From this study epirubicin appears as effective as doxorubicin as part of induction therapy for adult ALL. However, the results need to be validated on the basis of immunophenotype and cytogenetic prognostic characterization. Am. J. Hematol. 71: 241-247, 2002.

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New Cytotoxic Drugs in Treatment of Breast Cancer

Cited by 22 publications

References 27 publications

The effects of chemotherapy on breast cancer tissue in locally advanced breast cancer

The effects of chemotherapy on breast cancer tissue in locally advanced breast cancer

Doxorubicin vs epirubicin, report of a second-line randomized phase II/III study in advanced breast cancer

Randomized study comparing 4′‐epi‐doxorubicin (Epirubicin) versus doxorubicin as a part of induction treatment in adult acute lymphoblastic leukemia

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