Giuseppe Cancello1, Vincenzo Bagnardi2, Claudia Sangalli3, Emilia Montagna3, Silvia Dellapasqua3, Andrea Sporchia3, Monica Iorfida3, Giuseppe Viale4, Massimo Barberis5, Paolo Veronesi6, Alberto Luini7, Mattia Intra7, Aron Goldhirsch8, Marco Colleoni3. 1. Division of Medical Senology, European Institute of Oncology, Milan, Italy. Electronic address: giuseppe.cancello@ieo.it. 2. Division of Epidemiology and Biostatistics, European Institute of Oncology, and Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy. 3. Division of Medical Senology, European Institute of Oncology, Milan, Italy. 4. Department of Pathology, European Institute of Oncology, Milan, Italy; University of Milan School of Medicine, Milan, Italy. 5. Department of Pathology, European Institute of Oncology, Milan, Italy. 6. University of Milan School of Medicine, Milan, Italy; Division of Senology, European Institute of Oncology, Milan, Italy. 7. Division of Senology, European Institute of Oncology, Milan, Italy. 8. Program of Senology (Breast Health), European Institute of Oncology, Milan, Italy.
Abstract
BACKGROUND: The aggressive biological behavior and the lack of target therapy prompts the search for new therapeutic approaches for triple-negative breast cancers. PATIENTS AND METHODS: We evaluated the efficacy in terms of Ki-67 variation and clinical response but also the toxicity of a neoadjuvant regimen based on metronomic principles including ECF (epidoxorubicin with cisplatin on day 1 with low-dose 5-fluorouracil in continuous infusion every 21 days for 4 courses) followed by paclitaxel (90 mg/m(2)) on day 1, 8, and 15 every 28 days for 3 courses in combination with metronomic oral cyclophosphamide 50 mg/d for 12 weeks in patients with HER2-negative breast cancer (T2-T4a-d, N0-3, M0) with estrogen receptor and progesterone receptor < 10%. RESULTS: We enrolled 34 patients from June 2009 to May 2013. All were considered evaluable on an intention-to treat basis. The mean difference between the percentage of Ki-67 positive cells evaluated in surgical resection specimens and in pretreatment tumor core biopsy was 41% (95% confidence interval [CI], 30-51; P < .0001) for the entire population, and 22% (95% CI, 7-38; P = .0097) in patients who did not achieve pathological complete response (pCR). Responses to the treatment were obtained in 31 patients [91%] of the patients, and 19 patients (56%; 95% CI, 35-70) had a pCR. Stable disease was observed in 3 patients and none had progressive disease. Grade ≥ 3 hematologic adverse events included leukopenia in 9% (3 of 34), neutropenia in 38% (13 of 34), and anemia in 3% (1 of 34) of patients. Nonhematologic Grade ≥ 3 toxicities included only stomatitis in 1 patient. CONCLUSION: A neoadjuvant program with an ECF regimen followed by weekly paclitaxel with metronomic cyclophosphamide proved to be very effective, with high pCR rates, reduction of Ki-67, and it was associated with a low toxicity profile.
BACKGROUND: The aggressive biological behavior and the lack of target therapy prompts the search for new therapeutic approaches for triple-negative breast cancers. PATIENTS AND METHODS: We evaluated the efficacy in terms of Ki-67 variation and clinical response but also the toxicity of a neoadjuvant regimen based on metronomic principles including ECF (epidoxorubicin with cisplatin on day 1 with low-dose 5-fluorouracil in continuous infusion every 21 days for 4 courses) followed by paclitaxel (90 mg/m(2)) on day 1, 8, and 15 every 28 days for 3 courses in combination with metronomic oral cyclophosphamide 50 mg/d for 12 weeks in patients with HER2-negative breast cancer (T2-T4a-d, N0-3, M0) with estrogen receptor and progesterone receptor < 10%. RESULTS: We enrolled 34 patients from June 2009 to May 2013. All were considered evaluable on an intention-to treat basis. The mean difference between the percentage of Ki-67 positive cells evaluated in surgical resection specimens and in pretreatment tumor core biopsy was 41% (95% confidence interval [CI], 30-51; P < .0001) for the entire population, and 22% (95% CI, 7-38; P = .0097) in patients who did not achieve pathological complete response (pCR). Responses to the treatment were obtained in 31 patients [91%] of the patients, and 19 patients (56%; 95% CI, 35-70) had a pCR. Stable disease was observed in 3 patients and none had progressive disease. Grade ≥ 3 hematologic adverse events included leukopenia in 9% (3 of 34), neutropenia in 38% (13 of 34), and anemia in 3% (1 of 34) of patients. Nonhematologic Grade ≥ 3 toxicities included only stomatitis in 1 patient. CONCLUSION: A neoadjuvant program with an ECF regimen followed by weekly paclitaxel with metronomic cyclophosphamide proved to be very effective, with high pCR rates, reduction of Ki-67, and it was associated with a low toxicity profile.
Authors: X Wang; J Ren; J Zhang; Y Yan; N Jiang; J Yu; L Di; G Song; L Che; J Jia; X Zhou; H Yang; H K Lyerly Journal: Clin Transl Oncol Date: 2015-08-13 Impact factor: 3.405
Authors: Rui Xue Zhang; Tian Zhang; King Chen; Ji Cheng; Paris Lai; Andrew M Rauth; K Sandy Pang; Xiao Yu Wu Journal: J Vis Exp Date: 2017-10-05 Impact factor: 1.355
Authors: Diane Pannier; Antoine Adenis; Emilie Bogart; Eric Dansin; Stéphanie Clisant-Delaine; Emilie Decoupigny; Anne Lesoin; Eric Amela; Sandrine Ducornet; Jean-Pierre Meurant; Marie-Cécile Le Deley; Nicolas Penel Journal: BMC Cancer Date: 2018-07-31 Impact factor: 4.430