A phase II trial of neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin in the treatment of patients with locally advanced breast carcinoma

Louise E. Morrell, Young J. Lee, Judith Hurley, Mayda Arias, Carolyn Mies, Stephen P Richman, Hugo Fernandez, Kim A. Donofrio, William A. Raub, Peter A. Cassileth

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33 Citations (Scopus)

Abstract

BACKGROUND. Traditionally, primary surgical therapy is considered unsuitable for the treatment of patients with locally advanced breast carcinoma (LABC). Multiple reports have documented the efficacy of primary chemotherapy in this group of patients. The purpose of this study was to investigate the efficacy of a multimodality treatment program in reducing distant and local disease relapses in patients with LABC. METHODS. Fifty- five patients with large operable or inoperable Stage III breast carcinoma, median tumor greatest dimension 7 x 8 cm, were treated with neoadjuvant MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) to achieve maximum clinical response, followed by modified radical mastectomy, adjuvant MVAC for six courses, and chest wall radiation. Of these patients, 37 had Stage Ilia disease and 18 had Stage IIIB or inflammatory breast carcinoma. RESULTS. Forty-nine patients achieved overall responses to the neoadjuvant chemotherapy, including 16 complete clinical remissions. Histopathologic evaluation was performed for all patients; nine were pathologically free of disease and six had residual intraductal carcinoma only. After a median follow-up of 47 months (range, 8-76 months), 24 patients had relapsed: 6 locoregional and distant, and 18 distant only. The median disease free and overall survival have not been reached; the 5-year disease free and overall survival rates are 51% and 63%, respectively. The number of lymph nodes with metastases was found to be an independent predictor of relapse in univariate and multivariate analyses. CONCLUSIONS. This multidisciplinary approach produced an excellent local control rate and a respectable 5-year distant relapse free rate. Axillary lymphadenectomy after primary chemotherapy provides crucial prognostic information, which can be important in planning multimodality treatment of patients with LABC.

Original languageEnglish
Pages (from-to)503-511
Number of pages9
JournalCancer
Volume82
Issue number3
DOIs
StatePublished - Feb 1 1998

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Vinblastine
Methotrexate
Doxorubicin
Cisplatin
Breast Neoplasms
Therapeutics
Recurrence
Drug Therapy
Disease-Free Survival
Inflammatory Breast Neoplasms
Ilium
Modified Radical Mastectomy
Carcinoma, Intraductal, Noninfiltrating
Thoracic Wall
Lymph Node Excision
Multivariate Analysis
Survival Rate
Lymph Nodes
Radiation
Neoplasm Metastasis

Keywords

  • Breast carcinoma
  • Locally advanced breast carcinoma
  • Methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC)
  • Neoadjuvant chemotherapy
  • Primary chemotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

A phase II trial of neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin in the treatment of patients with locally advanced breast carcinoma. / Morrell, Louise E.; Lee, Young J.; Hurley, Judith; Arias, Mayda; Mies, Carolyn; Richman, Stephen P; Fernandez, Hugo; Donofrio, Kim A.; Raub, William A.; Cassileth, Peter A.

In: Cancer, Vol. 82, No. 3, 01.02.1998, p. 503-511.

Research output: Contribution to journalArticle

Morrell, Louise E. ; Lee, Young J. ; Hurley, Judith ; Arias, Mayda ; Mies, Carolyn ; Richman, Stephen P ; Fernandez, Hugo ; Donofrio, Kim A. ; Raub, William A. ; Cassileth, Peter A. / A phase II trial of neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin in the treatment of patients with locally advanced breast carcinoma. In: Cancer. 1998 ; Vol. 82, No. 3. pp. 503-511.
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T1 - A phase II trial of neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin in the treatment of patients with locally advanced breast carcinoma

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AU - Lee, Young J.

AU - Hurley, Judith

AU - Arias, Mayda

AU - Mies, Carolyn

AU - Richman, Stephen P

AU - Fernandez, Hugo

AU - Donofrio, Kim A.

AU - Raub, William A.

AU - Cassileth, Peter A.

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N2 - BACKGROUND. Traditionally, primary surgical therapy is considered unsuitable for the treatment of patients with locally advanced breast carcinoma (LABC). Multiple reports have documented the efficacy of primary chemotherapy in this group of patients. The purpose of this study was to investigate the efficacy of a multimodality treatment program in reducing distant and local disease relapses in patients with LABC. METHODS. Fifty- five patients with large operable or inoperable Stage III breast carcinoma, median tumor greatest dimension 7 x 8 cm, were treated with neoadjuvant MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) to achieve maximum clinical response, followed by modified radical mastectomy, adjuvant MVAC for six courses, and chest wall radiation. Of these patients, 37 had Stage Ilia disease and 18 had Stage IIIB or inflammatory breast carcinoma. RESULTS. Forty-nine patients achieved overall responses to the neoadjuvant chemotherapy, including 16 complete clinical remissions. Histopathologic evaluation was performed for all patients; nine were pathologically free of disease and six had residual intraductal carcinoma only. After a median follow-up of 47 months (range, 8-76 months), 24 patients had relapsed: 6 locoregional and distant, and 18 distant only. The median disease free and overall survival have not been reached; the 5-year disease free and overall survival rates are 51% and 63%, respectively. The number of lymph nodes with metastases was found to be an independent predictor of relapse in univariate and multivariate analyses. CONCLUSIONS. This multidisciplinary approach produced an excellent local control rate and a respectable 5-year distant relapse free rate. Axillary lymphadenectomy after primary chemotherapy provides crucial prognostic information, which can be important in planning multimodality treatment of patients with LABC.

AB - BACKGROUND. Traditionally, primary surgical therapy is considered unsuitable for the treatment of patients with locally advanced breast carcinoma (LABC). Multiple reports have documented the efficacy of primary chemotherapy in this group of patients. The purpose of this study was to investigate the efficacy of a multimodality treatment program in reducing distant and local disease relapses in patients with LABC. METHODS. Fifty- five patients with large operable or inoperable Stage III breast carcinoma, median tumor greatest dimension 7 x 8 cm, were treated with neoadjuvant MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) to achieve maximum clinical response, followed by modified radical mastectomy, adjuvant MVAC for six courses, and chest wall radiation. Of these patients, 37 had Stage Ilia disease and 18 had Stage IIIB or inflammatory breast carcinoma. RESULTS. Forty-nine patients achieved overall responses to the neoadjuvant chemotherapy, including 16 complete clinical remissions. Histopathologic evaluation was performed for all patients; nine were pathologically free of disease and six had residual intraductal carcinoma only. After a median follow-up of 47 months (range, 8-76 months), 24 patients had relapsed: 6 locoregional and distant, and 18 distant only. The median disease free and overall survival have not been reached; the 5-year disease free and overall survival rates are 51% and 63%, respectively. The number of lymph nodes with metastases was found to be an independent predictor of relapse in univariate and multivariate analyses. CONCLUSIONS. This multidisciplinary approach produced an excellent local control rate and a respectable 5-year distant relapse free rate. Axillary lymphadenectomy after primary chemotherapy provides crucial prognostic information, which can be important in planning multimodality treatment of patients with LABC.

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