Sequential administration of dose-dense epirubicin/cyclophosphamide followed by docetaxel/capecitabine for patients with HER2-negative and locally advanced or node-positive breast cancer
Yago Nieto (1, 6), José Manuel Aramendía (1), Jaime Espinós (1), Susana De la Cruz (1), Oscar Fernández-Hidalgo (1), Marta Santisteban (1), Leyre Arbea (2), Javier Aristu (2), Rafael Martínez-Monge (2), Marta Moreno (2), Luis Pina (3), Josu Sola (4), Gerardo Zornoza (5) and Fernando Martínez Regueira (5).
(1) Department of Medical Oncology, Clínica Universitaria de Navarra, Pamplona, Spain
(2) Department of Radiation Oncology, Clínica Universitaria de Navarra, Pamplona, Spain
(3) Department of Radiology, Clínica Universitaria de Navarra, Pamplona, Spain
(4) Department of Pathology, Clínica Universitaria de Navarra, Pamplona, Spain
(5) Department of Breast Surgery, Clínica Universitaria de Navarra, Pamplona, Spain
(6) UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 423, Houston, TX 77030, USA
Capecitabine is effective against metastatic breast cancer (MBC). We hypothesized that sequential treatment with dose-dense epirubicin/cyclophosphamide (EC) and docetaxel/capecitabine would be active and tolerable in the adjuvant/neoadjuvant setting.
In this prospective phase II clinical trial patients with HER2-negative and node-positive or locally advanced tumors were eligible to receive four cycles of EC (100/600 mg/m(2)) every 2 weeks with G-CSF on days 3-10, followed by four cycles of docetaxel/capecitabine (75/1,000 mg/m(2) b.i.d., days 1-14) every 3 weeks.
Fifty-five patients were enrolled with median age of 49, and 80% had hormone receptor-positive disease. The median tumor size was 2.5 cm, with a median of two axillary nodes involved. Seventy-five percent of the first 20 patients had grade 2/3 hand-foot syndrome (HFS). Dose reduction of capecitabine to 800 mg/m(2) reduced the grade 2/3 HFS incidence to 31% in the remaining patients. No grade 4/5 toxicities were observed. All 20 patients treated preoperatively responded, with 5 (25%) pathologic complete responses and 3 additional pT(0)N(1) tumors. At a median follow-up of 48 (range 28-60) months, the event-free and overall survival rates are 91 and 98%, respectively.
Sequential treatment with dose-dense EC followed by docetaxel/capecitabine, using a lower capecitabine dose than that approved for MBC, has an acceptable toxicity profile and encouraging activity when used as neoadjuvant or adjuvant treatment of breast cancer.
CITATION Cancer Chemother Pharmacol. 2010 Feb;65(3):457-65