Neoadjuvant chemotherapy in the combined modality approach of locally advanced nonmetastatic breast cancer

S. M. Swain, R. A. Sorace, C. S. Bagley, D. N. Danforth, J. Bader, M. N. Wesley, S. M. Steinberg, Marc E Lippman

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Abstract

We have treated 76 patients with locally advanced breast cancer, 31 with stage IIIA, 41 with stage IIIB, and 4 with stage IV disease, with primary induction chemotherapy including an attempted hormonal synchronization in 70 patients. All were treated to maximum objective clinical response before proceeding to any local therapy. Patients achieving a complete response with a negative repeat biopsy generally received radiation therapy while patients with residual disease, partial response (PR) or no change (NC) status received debulking surgery prior to radiation therapy. Regardless of response to induction chemotherapy, patients received at least 6 additional months of chemotherapy following local therapy. Initial doses of combination chemotherapy were escalated to targeted myelosuppression. The objective response rate to induction chemotherapy was 93% with 49% complete response (CR), 44% PR, and 7% NC. The median numbers of cycles of chemotherapy to achieve a CR, PR, or NC were 5, 3, and 5, respectively. Three patients who currently have PRs are still on chemotherapy with continued tumor regression. Of 37 patients achieving a CR to chemotherapy, 35 were assessed by biopsies to determine pathological evidence of response. Twenty-three of the 37 patients (62%) were proven to be complete responders with negative biopsies. Twenty-four patients have relapsed, 6 with stage IIIA, 16 with IIIB, and 2 with stage IV. Five patients have had locoregional relapses alone, 4 locoregional and distant, and 15 distant alone. Median time to progression is 35.9 months for stage IIIA and 34.2 months for stage IIIB. Median survival is 35.3 months for stage IIIB and is indeterminate for stage IIIA. This aggressive primary chemotherapy regimen with hormonal synchronization followed by local therapy appears to provide excellent control and encouraging early results on systemic disease control.

Original languageEnglish
Pages (from-to)3889-3894
Number of pages6
JournalCancer Research
Volume47
Issue number14
StatePublished - Sep 18 1987
Externally publishedYes

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Breast Neoplasms
Drug Therapy
Induction Chemotherapy
Biopsy
Radiotherapy
Combination Drug Therapy
Therapeutics
Recurrence
Survival
Neoplasms

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Swain, S. M., Sorace, R. A., Bagley, C. S., Danforth, D. N., Bader, J., Wesley, M. N., ... Lippman, M. E. (1987). Neoadjuvant chemotherapy in the combined modality approach of locally advanced nonmetastatic breast cancer. Cancer Research, 47(14), 3889-3894.

Neoadjuvant chemotherapy in the combined modality approach of locally advanced nonmetastatic breast cancer. / Swain, S. M.; Sorace, R. A.; Bagley, C. S.; Danforth, D. N.; Bader, J.; Wesley, M. N.; Steinberg, S. M.; Lippman, Marc E.

In: Cancer Research, Vol. 47, No. 14, 18.09.1987, p. 3889-3894.

Research output: Contribution to journalArticle

Swain, SM, Sorace, RA, Bagley, CS, Danforth, DN, Bader, J, Wesley, MN, Steinberg, SM & Lippman, ME 1987, 'Neoadjuvant chemotherapy in the combined modality approach of locally advanced nonmetastatic breast cancer', Cancer Research, vol. 47, no. 14, pp. 3889-3894.
Swain SM, Sorace RA, Bagley CS, Danforth DN, Bader J, Wesley MN et al. Neoadjuvant chemotherapy in the combined modality approach of locally advanced nonmetastatic breast cancer. Cancer Research. 1987 Sep 18;47(14):3889-3894.
Swain, S. M. ; Sorace, R. A. ; Bagley, C. S. ; Danforth, D. N. ; Bader, J. ; Wesley, M. N. ; Steinberg, S. M. ; Lippman, Marc E. / Neoadjuvant chemotherapy in the combined modality approach of locally advanced nonmetastatic breast cancer. In: Cancer Research. 1987 ; Vol. 47, No. 14. pp. 3889-3894.
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