RESULTS OF 3 NEOADJUVANT CHEMOTHERAPY REG IMEN FOR OPERABLE BREAST-CANCER

In order to avoid modified radical mastectomy, a neoadjuvant approach was adapted in our institute for operable bulky breast cancers. From J anuary, 1982, to December, 1995, 288 patients received primary chemoth erapy with 3 different regimens (all doses mg/m(2)): (1) AVCF/AVCFM, 1 67 patients (adriamycin 30, vincristine 1 dl, cyclophosphamide 300, fl uorouracil 400 d2-d5 and methotrexate 20 d2 and d4, every 28 days); (2 ) NEM, 78 patients (vinorelbine 25, epirubicin 35, methotrexate 20 dl and d8, every 28 days); and (3) TNCF, 43 patients (THP-adria 20, d1-d3 , vinorelbine 25 dl and d4, cyclophosphamide 300, fluorouracil 400 d1- d4, every 21 days). Evaluation of the response comprised 3 methods: cl inical (C), echographic (E), mammographic (M). The overall objective r esponse rate (C: 63/90/93; E: 49/61/85; M: 53/65/83%) is higher with r egimens (2) and (3). The complete response rate was increased 2-fold w ith TNCF but the hematologic toxicity was very superior with this comb ination. Patients were all operated for (2) and (3), only several for (I), and the breast conservation rate (68/83/79%) was quite similar in the 3 regimens. The pathological complete response rate reached 23% w ith TNCF. However the impact on patient survival has to be confirmed.