Preoperative therapy with epidoxorubicin and docetaxel plus trastuzumab in patients with primary breast cancer: a pilot study

Wenzel, Catharina; Hussian, Dagmar; Bartsch, Rupert; Pluschnig, Ursula; Locker, Gottfried J.; Rudas, M.; Gnant, Michael; Jakesz, R.; Zielinski, Christoph; Steger, Guenther G.

doi:10.1007/s00432-004-0559-6

Cited by 43 publications

(15 citation statements)

References 16 publications

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“…One could speculate that cells released during taxane treatment may have become better accessible to the antibody, which otherwise has difficulties penetrating into the tumor tissue [42]. Indeed, in trials in which trastuzumab was added to a chemotherapy containing taxane, a significant increase in pCR [20,43] has been observed in patients with her2/neupositive disease. This was also confirmed in the small sample of patients in this trial, with 3/14 patients achieving complete pathological response.…”

Section: Discussionmentioning

confidence: 99%

The relevance of circulating epithelial tumor cells (CETC) for therapy monitoring during neoadjuvant (primary systemic) chemotherapy in breast cancer

Camara

Rengsberger²,

Egbe

et al. 2007

Annals of Oncology

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Background: Having demonstrated in a previous report that the response of circulating epithelial tumor cells (CETC) during the first cycles of primary (neoadjuvant) chemotherapy perfectly reflects the response of the tumor, in the present study the changes in cell numbers during subsequent cycles and their possible impact on the therapy's outcome were examined. Patients and methods:In 58 breast cancer patients CETC were quantified during therapy with either EC (epirubicin/ cyclophosphamid) or dose intensified E (epirubicin) followed by taxane, with or without trastuzumab, and subsequent CMF (cyclophosphamid/methorexate/ fluorouracil).Results: CETC numbers declined more than 10-fold (good response) in 65% (her2/neu-negative) and 55% (her2/neu-positive) of patients during EC, and in 60% during dose intensified E, respectively, followed by an increase of CETC in all patients. CETC remained increased, decreasing only when adding CMF. A good initial response correlated with estrogen-receptor negativity, a poor response with early distant relapse (P < 0,0001, hazard ratio = 11.91). Conclusion:Response of CETC already during the first cycles of neoadjuvant treatment predicts the final response of the tumor. Hitherto unknown effects of the release of tumor cells during therapy further our understanding of tumor-blood interaction and may improve access of agents like antibodies to cells. The impact on the further course of disease remains to be evaluated.

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Section: Discussionmentioning

confidence: 99%

The relevance of circulating epithelial tumor cells (CETC) for therapy monitoring during neoadjuvant (primary systemic) chemotherapy in breast cancer

Camara

Rengsberger²,

Egbe

et al. 2007

Annals of Oncology

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“…A number of small phase II trials have studied different combinations of preoperative trastuzumab and chemotherapy. In these studies, the pCR rates ranged from 12%-45% [40][41][42][43][44][45][46][47].…”

Section: Neoadjuvant Chemotherapy In Her-2-positive Breast Cancermentioning

confidence: 99%

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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“…To further improve the clinical and pathologic response rates, a pilot study evaluated the safety and efficacy of preoperative epidoxorubicin (epirubicin; Ellence ® ; Pfizer Pharmaceuticals) and docetaxel plus trastuzumab in 14 outpatient breast cancer patients [59]. Preoperative treatment consisted of weekly trastuzumab (4 mg/kg body weight loading dose, 2 mg/kg per week maintenance dose) in combination with weekly epidoxorubicin (30 mg/m 2 ) and docetaxel (35 mg/m 2 ) once a week for 6 weeks fol-lowed by 1 week off therapy.…”

Section: Docetaxel-trastuzumab Combinationsmentioning

confidence: 99%

Weekly Administration of Docetaxel and Paclitaxel in Metastatic or Advanced Breast Cancer

2005

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Preoperative therapy with epidoxorubicin and docetaxel plus trastuzumab in patients with primary breast cancer: a pilot study

Abstract: We conclude that outpatient epidoxorubicin and docetaxel plus trastuzumab are safe in the neoadjuvant treatment of patients suffering from breast cancer, based on a favorable side-effect and activity profile. Thus, this regimen can be considered for further clinical trials.

Cited by 43 publications

References 16 publications

The relevance of circulating epithelial tumor cells (CETC) for therapy monitoring during neoadjuvant (primary systemic) chemotherapy in breast cancer

The relevance of circulating epithelial tumor cells (CETC) for therapy monitoring during neoadjuvant (primary systemic) chemotherapy in breast cancer

Primary Systemic Therapy of Breast Cancer

Weekly Administration of Docetaxel and Paclitaxel in Metastatic or Advanced Breast Cancer

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