Maximized reduction of primary breast tumor size using preoperative chemotherapy with doxorubicin and docetaxel

Purpose: To assess the toxicity and efficacy of preoperative chemotherapy w ith doxorubicin and docetaxel in patients with primary operable breast canc er. Patients and Methods: Forty-two patients with histologically confirmed prim ary breast cancer tumors of at least 2 cm in diameter received doxorubicin (50 mg/m(2) intravenously [IV] over 15 minutes) and docetaxel (75 mg/m(2) I V over 1 hour) every 14 (24 patients) or 21 (18 patients) days for four cyc les. Results: The median size of the primary tumor decreased significantly, from 4 cm (range, 2 to 10 cm) to 2 cm (range, 0 to 5 cm) on physical examinatio n and from 3.4 cm (range, 1 to 8 cm) to 1.8 cm (range, 0 to 4 cm) on sonogr aphy (P < .001). The overall response rate as assessed by physical examinat ion was 93%, and complete remission of the primary tumor occurred in 33% of patients. The remission rate as assessed by sonographic measurement was 67 %. Two patients (5%) had histologically confirmed complete responses. Sonog raphy was more reliable than palpation in predicting histologically determi ned response. No grade 4 toxicity was noted, and grade 3 toxicity was repor ted with alopecia (95%), lethargy (17%), loss of appetite (10%), stomatitis (7%), leukopenia (5%), skin desquamation (5%), infection (5%), motor neuro pathy (2%), and nausea (2%). The 3-week schedule war associated with less t oxicity than the 2-week schedule. Conclusion: Preoperative combination chemotherapy with doxarubicin and doce taxel is highly effective and feasible in primary operable breast cancer, ( C) 1999 by American Society of Clinical Oncology.