Epirubicin in breast cancer patients with liver metastases and abnormal liver biochemistry: initial weekly treatment followed by rescheduling and intensification.

Fifty-two consecutive patients with breast cancer and liver metastases have been treated with epirubicin. All had a serum aspartate aminotransferase more than twice the upper limit of normal or a raised bilirubin. Initial treatment was with 6 cycles of weekly epirubicin 25 mg/m2. In patients whose liver biochemistry improved sufficiently, treatment was then changed to a 3-weekly schedule and an attempt was made to increase dose-time intensity during a further 6 cycles of epirubicin. The UICC response rate was 15/52 (29%, with 95% confidence intervals 18-42%) and median response duration was 34 weeks. All 23 patients who were eligible for rescheduling received epirubicin 3-weekly, but escalation of dose intensity was possible in only 5 patients. The activity and tolerability of weekly epirubicin has been confirmed in patients with liver metastases from breast cancer. However, late dose escalation was impracticable in the majority of patients and did not appear to improve outcome.