High complete pathological response in locally advanced breast cancer using paclitaxel and cisplatin.

BACKGROUND: In an earlier study, we have demonstrated a high response rate in metastatic breast cancer using paclitaxel (P) and cisplatin (C). A phase II study using the same regimen (PC) has been conducted in locally advanced breast cancer (LABC). METHODS: A total of 72 consecutive patients with non-inflammatory LABC (T2 > or = 4 cm, T3 or T4, N0-N2, M0). Patients were scheduled to receive 3-4 cycles of the neoadjuvant PC (paclitaxel 135 mg/m2 and cisplatin 75 mg/m2 on day 1) every 21 days. Patients were then subjected to surgery and subsequently received 6 cycles of FAC (5-fluorouracil 500 mg/m2, doxorubicin 50 mg/m2, and cyclophosphamide 500 mg/m2) or 4 cycles of AC (doxorubicin 60 mg/m2, and cyclophosphamide 600 mg/m2). Patients then received radiation therapy, and those with hormone receptor positive tumors were given adjuvant tamoxifen intended for 5 years. RESULTS: The median age was 39 years (range, 24-78). Clinically, 7%, 58%, and 35% of patients had T2 > or = 4 cm, T3, and T4, respectively. Disease stage at diagnosis was IIB (33%), IIIA (27%), and IIIB (40%). Complete and partial clinical response to PC was demonstrated in 13 (18%), and 52 (72%) patients, respectively. Of those patients with evaluable pathologic response (68 patients), complete pathologic response (pCR) was achieved in 15 (22%) patients. At a median follow-up of 22 (+/- 3.5) months, 58 (81%) were alive with no recurrence, nine (12%) were alive with evidence of disease, and five (7%) were dead. None of the patients achieving pCR has developed any relapse. The median overall survival has not been reached for all 72 patients with a projected 3-year survival (+/- SE) of 90% (+/- 4%). The median progression-free survival (PFS) was 42.1 (+/- 4.8) months with a projected PFS of 74% +/- 7% at 3-years (for 68 patients). CONCLUSIONS: PC regimen in LABC produced a high pCR. The contribution of the other added modalities to survival could not be assessed.

Ki-1 large cell lymphoma: A clinical study of 12 cases.

The treatment and prognosis of Ki-1 positive lymphoma, a relatively new entity, remains largely unknown and the clinical features are still being defined. This is a retrospective analysis of our experience with 12 patients with Ki-1 lymphoma who were treated at our hospital over two years. Clinical presentation and management are described and an attempt is made to identify prognostic factors. The median age at presentation was 20 and the male/female ratio 1:1. Nine patients presented with nodal disease and three with extranodal. B symptoms were present in seven patients. Seven patients had stage I/II disease and five had stage IV. Immunophenotyping was available in 10 patients of which five were T-cell, two B-cell, and two null cell; one could not be categorized. All 12 patients received combination chemotherapy; five had consolidation radiotherapy. With a median follow-up of 11 months (range one to 29), actuarial survival was 67% at 29 months and disease-free survival 50% for all patients. Five out of seven patients with stage I/II and one out of five with stage IV remain disease free. We conclude that the clinical presentation is diverse and advanced stage appears to be the only identifiable adverse prognostic factor.