CLINICAL AND PATHOLOGICAL RESPONSE TO PRIMARY CHEMOTHERAPY IN OPERABLE BREAST-CANCER

Neoadjuvant chemotherapy is used to improve patients' survival in loca lly-advanced and inflammatory breast cancer and to increase conservati ve surgical procedures in bulky tumours. Pathological complete respons es are unusual. The aim of this pilot study was to assess the clinical and pathological response rates and to evaluate toxicity with a new p rotocol of primary chemotherapy in 50 high-risk breast cancer patients . All tumours were >3 cm and had at least one other adverse prognostic factor: lymph node involvement (32 N1, 6 N2), SBR grade III (20), ane uploidy (29), negative hormonal receptors (19). Patients were treated by 3-week cycles of THP-doxorubicin 20 mg/m(2) D1 to 3, vinorelbine 25 mg/m(2) D1 and 4, cyclophosphamide 300 mg/m(2) and 5-fluorouracil 400 mg/m(2) D1 to 4 (TNCF). 38 patients received G-CSF or GM-CSF support. After 4-6 cycles, all underwent surgery (39 conservative, 11 modified radical). Tumour response was assessed clinically by mammography and echography and on pathological specimens. An objective clinical respon se was observe for 43 patients: 26 complete (51%) and 18 partial (37%) . After pathological review, 11 patients (22%) were devoid of amy tumo ur cells, 4 others (8%) had only in situ carcinoma. From 253 evaluated cycles, grade III-IV toxicity occurred, 81% with neutropenia, 25% wit h anaemia, and 20% with thrombocytopenia. All patients recovered. This regimen induced a severe but not life-threatening haematological toxi city and resulted in a high pathological response rate (30%). (C) 1997 Elsevier Science Ltd.