INDUCTION CHEMOTHERAPY WITH CISPLATIN, DOXORUBICIN, AND CYCLOPHOSPHAMIDE (CAP) IN A COMBINED-MODALITY APPROACH FOR LOCALLY ADVANCED AND INFLAMMATORY BREAST-CANCER - LONG-TERM RESULTS

Thirty-one patients with locally advanced and inflammatory breast carc inoma (stage IIIA and IIIB) were treated with a combined modality appr oach between 1985 and 1989. All patients received as induction chemoth erapy a combination of cisplatin, doxorubicin, and cyclophosphamide (C AP). Responsive patients and patients with operable stable disease und erwent modified radical mastectomy followed by concurrent radiotherapy and CMF (cyclophosphamide, methotrexate, 5-fluorouracil) adjuvant che motherapy. Thirty patients were evaluable for response to CAP. The rat e of objective response to induction chemotherapy was 76.7% with 2 pat ients (6.7%) obtaining a complete response and 21 pa tients (70%) a pa rtial response. Twenty-five patients were rendered disease-free after induction chemotherapy and surgery. Only 2 of these had pathological c omplete response (8%). The median overall survival was 48.7 months, th e median time to progression was 22.4 months and the median disease-fr ee survival was 29.1 months. The patients with noninflammatory breast tumor had a significantly better overall survival, disease-free surviv al, and time to progression. The overall survival and the time to prog ression were statistically superior in patients with primary tumor siz e less than or equal to 8 cm. At a median follow-up of 6 years, 29% (9 5% CI, 13.05 to 45.01) of patients were alive and 28% (95% CI, 10.4 to 45.6) were disease-free. This combined modality treatment seems feasi ble with quite acceptable toxicity; the CAP combination is an effectiv e alternative to the other standard chemotherapeutic regimens. Our res ults, although encouraging, are still poor, and new drugs and strategi es are required to improve the long-term outcome.