High-dose epirubicin and cyclophosphamide every two weeks as first-line chemotherapy for relapsing metastatic breast cancer patients

Background: Metastatic breast cancer remains incurable with conventional ch emotherapy. For any specific chemotherapy, higher dose intensity may be ach ieved with either increased doses per cycle, or shortened intervals between courses, or both. We demonstrate here the feasibility and encouraging resu lts of a high-dose combination regimen administered every two weeks. Patients and methods: Women with metastatic breast cancer were treated ever y 14 days for 6 courses with 75 mg/m(2) epirubicin and 1200 mg/m(2) cycloph osphamide, followed by conventionally-delivered (q 3-4 weeks) chemotherapy. The treatment was to be resumed regardless of the neutrophil count, except in instances of febrile neutropenia. Prophylactic oral antibiotherapy was given, while hematopoietic growth factors and stem cell support were not em ployed. Results: Eighty-six patients were treated between May 1986 and June 1995. T heir median age was 43 years (26-69). Grade 3-4 neutrophil toxicity was obs erved after 86% of the courses, resulting in febrile neutropenia in 5%-18% of the patients, and the rehospitalization of 5%-10%. The median given/plan ned dose intensity was 97% (79-106). The objective response rate in 84 eval uable patients was 54% (95% confidence interval (95% CI): 43-65), with a co mplete response rate of 11%, and a 14% rate of outright progression. Median progression-free survival was 16 months and median overall survival 32 mon ths. Multivariate analysis retained previous adjuvant chemotherapy as a neg ative survival prognostic factor. Conclusions: This dose-intensive anthracycline-based regimen is feasible wi th manageable morbidity despite pronounced myelotoxicity, and yields encour aging survival rates.