Anthracycline could be essential for triple-negative breast cancer: A randomised phase II study by the Kanagawa Breast Oncology Group (KBOG) 1101.

BACKGROUND: It is important to determine whether anthracycline-containing regimens or taxane-containing regimens are more effective in individual patients. The present study compared the efficacy of six cycles of docetaxel and cyclophosphamide (TC6) with that of three cycles of 5-fluorouracil, epirubicin and cyclophosphamide followed by docetaxel (FEC-D) in Japanese patients with hormone receptor (HR)-negative breast cancer (BC) to identify subtypes requiring anthracycline treatment. METHODS: The study included 103 patients with operable HR-negative BC. Of these patients 53 received FEC-D and 50 received TC6. The primary endpoint was pathological complete response (pCR). The secondary endpoints were safety, breast-conserving surgery, disease-free survival (DFS) and overall survival (OS). The predictive factors for each regimen were evaluated. RESULTS: Of the 103 patients, 97 completed the study (FEC-D, 50 patients; TC6, 47 patients). The pCR rate was higher with FEC-D (36%) than with TC6 (25.5%); however, the difference was not significant (P = 0.265). TC6 was safer than FEC-D, as the adverse events with docetaxel in the FEC-D regimen were similar to those with the TC6 regimen. Among patients with basal BC, the pCR rate was significantly higher with FEC-D (42.9%) than with TC6 (13.6%; P = 0.033). Among patients with triple-negative breast cancer (TNBC), the DFS and OS were significantly better with FEC-D than with TC6 (P = 0.016 and P = 0.034, respectively). CONCLUSION: TC6 was not as effective as FEC-D for treating HR-negative BC, as TC6 was not sufficient to treat TNBC, particularly the basal subtype. Our findings suggest that anthracyclines are better treatment options than taxanes for basal BC.

Feasibility Study of Weekly Nanoparticle Albumin-Bound Paclitaxel (150 mg/m2) Followed by Fluorouracil, Epirubicin, and Cyclophosphamide Therapy as Neoadjuvant Chemotherapy for HER2-Negative Breast Cancer.

BACKGROUND: Although several studies have shown efficacy of nanoparticle albumin-bound (nab) paclitaxel use as a neoadjuvant treatment in breast cancer, dosage and schedules were varied or used in combination and the data are still limited for weekly regimens. We evaluated the feasibility of weekly nab-paclitaxel followed by FEC (5-FU [fluorouracil], epirubicin, and cyclophosphamide) treatment feasibility as neoadjuvant chemotherapy for breast cancer. PATIENTS AND METHODS: Thirty-three patients with no previous chemotherapy were enrolled to receive nab-paclitaxel 150 mg/m2 the first 3 of 4 weeks (3q4w) followed by FEC as neoadjuvant treatment. The trial was powered for analyses of feasibility. RESULTS: Twenty-five patients completed the treatment as per protocol, and the completion rate was 75.8% (95% confidence interval, 59.0-87.2; P = .44). The regimen completion group was younger than those with regimen incompletion (average 45.1 vs. 56.6 years). The pathological complete response (ypT0-is/N0) rate was 30.3% in 33 patients, which was higher in triple-negative patients (58.3%). Grade 3/4 neutropenia was seen in 48.5%, although there was no febrile neutropenia. Grade 3 peripheral neuropathy was seen in 33.3%. CONCLUSION: Our study showed that weekly nab-paclitaxel 150 mg/m2 3q4w followed by FEC as neoadjuvant regimen might be sufficient in efficacy, although with a relatively high severe adverse event occurrence rate.

Determining the morphological features of breast cancer and predicting the effects of neoadjuvant chemotherapy via diagnostic breast imaging.

BACKGROUND: Neoadjuvant chemotherapy has recently become common therapy for breast cancer. This work studied whether or not the effects of neoadjuvant chemotherapy can be predicted from morphological features of breast cancer in initial diagnostic imaging. MATERIALS AND METHODS: A total of 186 cases who underwent neoadjuvant chemotherapy at this hospital in 2006 were studied. Morphological features were classified into four categories. One is a type of invasive carcinoma that tends to grow along the mammary ducts (type A1), another is a type of expansively growing invasive carcinoma that is relatively well-defined (type A2), a third is a type of irregularly shaped mass that retracts surrounding tissue (type A3), and the fourth is a mixed type. Thus, the effects of neoadjuvant chemotherapy on carcinomas of the four types were compared on the basis of image and pathological findings. Effects of neoadjuvant chemotherapy were classified into three categories of enlarged mass, pCR, and other, with the latter indicating no change or shrinkage. RESULTS: Of the 186 total cases, 72 were classified as type A1, 31 as type A2, 52 as type A3, and 31 as a mixed type. Seven of 31 cases of type A2 (22.6%) were cases of an enlarged mass, revealing a high percentage of such cases. Dividing cases into type A2 and other types and looking at the proportion of cases of an enlarged mass thus indicated a significantly higher tendency. pCR was achieved in 6 of 31 cases with type A2 (19.4%). Here, also, the proportion of type A2 cases was significantly higher. CONCLUSION: Morphological features prior to neoadjuvant chemotherapy can contribute to determining the effects of the therapy. Expansively growing well-defined masses contain lesions at both extremes, tending to enlarge in some instances or instead allowing pCR, so the course of therapy must be carefully followed when performing neoadjuvant chemotherapy.