Triple‐negative breast cancer: multipronged approach, single‐arm pilot phase II study

• Published in: Cancer medicine (Malden, MA) Vol. 1; no. 1; pp. 89 - 95
• Main Authors: Recchia, Francesco, Candeloro, Giampiero, Desideri, Giovambattista, Necozione, Stefano, Recchia, Cornelia O. C., Cirulli, Vincenzo, Rea, Silvio
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.08.2012; Blackwell Publishing Ltd
• Subjects: 5-Fluorouracil; Adult; Aged; Anthracycline; Antigens; Breast cancer; Cancer therapies; Carboplatin; Chemoradiotherapy; Chemotherapy; Clinical Cancer Research; Combined Modality Therapy - adverse effects; Concurrent chemotherapy and radiation therapy; Cyclophosphamide; Drug dosages; Epirubicin; Etoposide; Family medical history; Female; Gene expression; Growth factors; Hematology; high‐dose chemotherapy; Humans; Ifosfamide; Mammography; Mastectomy; Medical prognosis; Metastasis; Methotrexate; Middle Aged; Patients; Pilot Projects; Platinum; platinum analogues; Radiation therapy; Studies; Survival; Taxanes; Toxicity; Treatment Outcome; Triple Negative Breast Neoplasms - diagnosis; Triple Negative Breast Neoplasms - mortality; Triple Negative Breast Neoplasms - therapy; triple‐negative breast cancer; Tumors; Vascular endothelial growth factor; Womens health; triple-negative breast cancer; platinum analogues; Concurrent chemotherapy and radiation therapy; high-dose chemotherapy
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.3

Anthracyclines (A) and taxanes (T) are standard first‐line chemotherapy agents for patients with advanced breast cancer. Platinum analogues have also shown activity in the triple‐negative breast cancer (TNBC) histology, but clinical data are limited. Here we report the long‐term follow‐up of a phase II study on TNBC treated with a combined modality therapy, including induction with AT, cyclophosphamide, methotrexate, and 5‐fluorouracil (CMF) with concurrent radiation therapy, and a dose‐dense consolidation chemotherapy (HDCT) with carboplatin (CBDCA), ifosfamide (IFX), etoposide (VP‐16). Patients' median age was 44 years, with 73% premenopausal. Epirubicin 75 mg/m2 and docetaxel 75 mg/m2 were administered to 70 patients with TNBC: as neoadjuvant and adjuvant therapy to 12 and 58 patients, respectively. Postoperative radiation therapy, 5000 cGy, was delivered, synchronous with triweekly CMF. After radiation therapy, two courses of HDCT with CBDCA, IFX, VP‐16, were given, with hematological growth factors. After a median follow‐up of 81 months, all patients were evaluable for toxicity and response. Most important toxicity were grade 3 skin reaction and grade 4 hematological in 3% and 31% of patients, respectively. Pathological complete response was observed in 25% of patients receiving preoperative chemotherapy. Treatment failures were as follows: eight visceral, four contralateral breast cancer, four locoregional, and one leukemia. Five‐year progression‐free survival and overall survival rate were 78% and 91%, respectively. Induction chemotherapy, followed by chemoradiation therapy and HDCT, provides a prolonged disease‐free period and a significant increase in overall survival in TNBC, with an acceptable toxicity profile. Multidisciplinary approach in triple negative breast cancer. High‐dose chemotherapy. Platinum analogues.