The Changes in Residual Cancer Burden after Interval Debulking Surgery Are Effective in Evaluating the Response to Adjuvant Chemotherapy

Background: Despite the growing number of clinical trials assessing preoperative systemic chemotherapy (PST) for locally advanced breast cancer, the optimal regimen has still to be defined. Purpose: This was to evaluate the toxicity, operability rate, pathological response rate and disease-free and overall survival associated with a PST regimen consisting of the sequential administration of single agents according to the individual tumor response. Methods: Medical files were reviewed of 102 consecutive patients with breast cancer treated in 2000–2007 with a neoadjuvant sequential regimen of doxorubicin followed by taxane. The number of cycles and the addition of taxane were based on tumor response. Results: Seventy percent of the patients had inoperable disease at diagnosis and 29% were given preoperative therapy for breast conservation. All patients underwent surgery, 65% achieved breast conservation. An overall pathological complete response (breast and nodes) was achieved in 14% of the patients, and a complete nodal pathologic response in 34%. At a median follow-up of 54 months, the overall survival rate was 82% and the disease-free survival rate was 70%. There was no treatment-related mortality. Febrile neutropenia occurred in 19% of the patients. Conclusions: A neoadjuvant regimen of doxorubicin with or without a sequential taxane, in which the number of cycles and the sequential administration of taxane are determined according to clinical response, appears to be safe and effective for patients with locally advanced breast cancer and yields a high rate of breast conservation. Tailored PST can spare patients receiving unnecessary chemotherapy.

Section: Discussionmentioning

confidence: 85%

Tailoring Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer: A Historical Prospective Study

Zer

Rizel

Braunstein³

et al. 2012

“…The majority of patients present with advanced disease and are treated with surgery followed by postoperative platinum- and taxane-based chemotherapy [2,3]. Use of intravenous (IV) paclitaxel and cisplatin chemotherapy in patients with advanced-stage (stage III or IV) EOC, fallopian tube or primary peritoneal cancer is associated with a median overall survival (OS) of approximately 38 months in patients with suboptimally debulked disease (residual tumor >1.0 cm in diameter) and 49 months in those with optimally debulked disease (residual tumor ≤1.0 cm in diameter) [4,5].…”

Section: Introductionmentioning

confidence: 99%

Safety and Outcome of Patients Treated with a Modified Outpatient Intraperitoneal Regimen for Epithelial Ovarian, Primary Peritoneal or Fallopian Tube Cancer

Battelli¹,

Campo²,

Buss³

et al. 2013

Background: Despite the survival benefit of intraperitoneal (IP) chemotherapy observed in GOG172, significant toxicity and poor treatment completion rates have prevented the widespread acceptance of this regimen. Here, we report our experience with a modified outpatient GOG172 regimen. Methods: Eligible patients had stage III, optimally debulked epithelial ovarian, fallopian tube or primary peritoneal cancer that underwent IP port placement for administration of a modified GOG172 regimen consisting of: (i) intravenous paclitaxel 135 mg/m² on day 1 over 3 h; (ii) intraperitoneal cisplatin 75 mg/m² on day 2, and (iii) intraperitoneal paclitaxel 60 mg/m² on day 8. Day 8 IP paclitaxel was omitted until tolerance of the first cycle of IP cisplatin had been established. Results: Four or more cycles of IP chemotherapy were completed by 72.5% (29) of 40 eligible patients; 20% of patients exhibited catheter-related complications requiring port removal and discontinuation of IP chemotherapy. Grade 3-4 hematologic, metabolic and gastrointestinal toxicities occurred in 36, 8 and 21% of the patients, respectively. With a median follow-up of 47.7 months, progression-free and overall survival was comparable to GOG172. Conclusions: This modified outpatient GOG172 regimen is associated with less toxicity and improved completion rates compared to the original GOG172 regimen.

“…Carboplatin and paclitaxel in combination is the standard postsurgery treatment for advanced ovarian cancer [1,2]. Carboplatin has replaced cisplatin due to its better toxicity profile and similar efficacy in randomized clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Association between High Antitumor Activity of Oxaliplatin and Cyclophosphamide and Constitutional GSTM1 Homozygous Deletion in an Advanced Ovarian Cancer Patient

Gataa

Emile²,

Loriot³

et al. 2013

Background: Although the efficiency of oxaliplatin in patients with advanced ovarian cancer has been demonstrated, it is not commonly used. In cells, oxaliplatin is metabolized by the enzymes belonging to the glutathione-S-transferase (GST) family. Case: A 55-year-old woman with advanced ovarian cancer received 6 cycles of paclitaxel and carboplatin after debulking surgery. Six months later, she experienced a clinical recurrence. A second-line chemotherapy combining 500 mg/m² cyclophosphamide with 100 mg/m² oxaliplatin was initiated and maintained for 10 cycles. The patient thus experienced a second complete remission that lasted for 6 years. We found that she had deficient GSTM1 enzyme activity with homozygous deletion and normal GSTP1 and GSTT1 activities. Conclusion: The association of a homozygous deletion of GSTM1 with hypersensitivity to oxaliplatin and cyclophosphamide combination chemotherapy has not been described to date in ovarian cancer. Further study of its potential interest to personalized second-line therapy in these patients is called for.