Successful neoadjuvant therapy with trastuzumab, paclitaxel and epirubicin for an elderly patient with inflammatory breast cancer.

A 75-year old woman presented with diffuse left breast enlargement, redness, edema, and a firm palpable lymph node with skin fixation in the left axilla. The tumor was diagnosed as invasive ductal carcinoma with a strongly positive human epidermal growth factor receptor 2 (HER2) score (3+). She was diagnosed as having inflammatory breast cancer (IBC) (T4d N2M0, stage IIIb). The patient received primary systemic chemotherapy with 4 courses of epirubicin 75 mg/m(2) and cyclophosphamide 500 mg/m(2) every three weeks, then 12 courses of paclitaxel 80 mg/m(2) and trastuzumab 2 mg/kg (initially 4 mg/kg) weekly. Six months after the start of chemotherapy, a left modified radical mastectomy with axillary dissection was performed. No cancer cells in the breast specimen and no metastases to the axillary nodes were observed, so the therapeutic effect was determined as a pathological complete response (pCR). This report suggests that combination therapy with epirubicin and cyclophosphamide followed by trastuzumab and paclitaxel was useful for HER2-positive IBC.

High-grade breast cancers include both highly sensitive and highly resistant subsets to cytotoxic chemotherapy.

PURPOSE: We reported that breast cancers achieving pathological complete response (pCR) or progressive disease (PD) to neoadjuvant chemotherapy (NAC), which are considered exact opposites on the chemosensitivity spectrum, have certain clinicopathological features in common. To determine the highly sensitive and highly resistant subsets to cytotoxic chemotherapy, we evaluated predictive factors for pCR and PD to NAC, and assessed the similarities in these factors. METHODS: Subjects comprised 300 women with 304 stage II or III breast cancers treated with chemotherapy that was anthracycline-based, taxane, or both, followed by surgery between 2007 and 2008. We retrospectively evaluated pre-NAC clinicopathological features including chemotherapy regimen, clinical T stage, nuclear grade (NG), hormone receptor (HR) status, and human epidermal growth factor receptor-2 (HER2) status in pCR and PD, using univariate chi(2) testing and multivariate logistic regression analyses. RESULTS: Of 304 tumors, 30 (10%) achieved pCR and 22 (7%) showed PD to NAC. Multivariate analysis demonstrated that anthracycline plus taxane chemotherapy (P = 0.006), NG3 (P = 0.006), HR-negativity (P = 0.013), and HER2-positivity (P = 0.010) were significant predictors of pCR, and T3-4 (P = 0.002) and NG3 (P = 0.010) were significant predictors of PD. CONCLUSIONS: High-grade breast cancers include both highly sensitive and highly resistant subsets to cytotoxic chemotherapy. Three factors can help discriminate between these subsets. HR-negative and HER2-positive can be predictive of high chemosensitivity. Advanced primary tumor stage can be predictive of high chemoresistance.

Common and discriminative clinicopathological features between breast cancers with pathological complete response or progressive disease in response to neoadjuvant chemotherapy.

PURPOSE: To clarify clinicopathological similarities and differences between breast carcinomas that achieve pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) and those showing progressive disease (PD) during NAC, we compared pre-NAC clinicopathological characteristics between these tumors. METHODS: Subjects comprised 32 patients (6%) achieved pCR and 33 patients (7%) showed PD of 494 patients (498 breasts) with stage II or III breast carcinoma who underwent anthracycline-based or taxane chemotherapy or both, followed by surgery, between 2000 and 2006. We compared patient characteristics before NAC, and histomorphology, immunohistochemistry, and molecular subtypes of tumors using pre-NAC biopsy samples. Immunohistochemistry included estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor-2 (HER2), epidermal growth factor receptor (EGFR), cytokeratin 5/6 (CK5/6). Molecular subtypes were defined by ER, PgR, HER2, EGFR, and CK5/6. We compared these factors between pCR and PD using univariate chi (2) testing and multivariate logistic regression analyses. RESULTS: No significant differences between groups were seen regarding NAC regimens. Solid-tubular carcinoma (53% of pCR, 61% of PD), histological grade 3 (78% of pCR, 79% of PD), ER-status (91% of pCR, 82% of PD), and basal-like subtype (44% of pCR, 58% of PD) were often observed in both groups. In multivariate analyses, lower clinical N stage at diagnosis (P = 0.004) and HER2/ER-PgR- subtype (P = 0.020) were significantly associated with pCR. CONCLUSIONS: Breast carcinomas achieving pCR or showing PD with NAC have common peculiar characteristics such as solid-tubular carcinoma, high grade, hormone receptor negativity, and basal-like subtype. Conversely, discriminative factors include clinical N stage at diagnosis and HER2/ER-PgR- subtype.

Epirubicin and cyclophosphamide followed by docetaxel as primary systemic chemotherapy in locally advanced breast cancer.

BACKGROUND: The aim of this study was to evaluate the activity and toxicity of epirubicin and cyclophosphamide (EC) followed by docetaxel as primary systemic chemotherapy (PST) in locally advanced breast cancer. PATIENTS AND METHODS: In this phase II trial, 46 patients with locally advanced breast cancer (T > 3 cm or N > 1) received epirubicin (90 mg/m2) and cyclophosphamide (600 mg/m2) every 3 weeks for four cycles, followed by docetaxel (70 mg/m2) every 3 weeks for four cycles. Primary endpoints were pathological and objective response in the breast and axilla, and toxicities. RESULTS: The clinical response rate was 80.4% (95% confidence interval, 68.9-91.9%). Pathological response evaluation revealed 6 complete responses (CR: 13.0%). Patients with ER-negative tumors had a significantly higher rate of pathological CR than the others (33.3% vs. 3.2%; p = 0.0105). Febrile neutropenia occurred in 4 patients (8.7%). CONCLUSION: EC followed by docetaxel is an active and well-tolerated treatment as PST for locally advanced breast cancer.

The combination of epirubicin plus docetaxel as neoadjuvant chemotherapy in locally-advanced breast cancer.

BACKGROUND: The purpose of this study was to evaluate the activity and toxicity of epirubicin plus docetaxel as neoadjuvant chemotherapy for locally advanced breast cancer. PATIENTS AND METHODS: In this single-center, phase II trial, twenty-one patients with locally advanced breast cancer (T>3 cm or N>1) received epirubicin (70 mg/m2) and docetaxel (60 mg/m2) on Day 1 of each cycle for up to 6 cycles. RESULTS: Clinically complete responses (CR) were observed in 5 patients and partial responses were observed in 14 patients. The clinical response rate was 90.5% (95% confidence interval, 78.0-99.9). Eleven patients (52.4%) underwent breast conserving surgery. Pathological response evaluation revealed 2 CR (9.5%). Grade 4 neutropenia was recorded in 81.0% of the patients and febrile neutropenia occurred in 1 patient. CONCLUSION: The combination of epirubicin plus docetaxel was an active and well-tolerated treatment for locally-advanced breast cancer.