Tailored preoperative treatment of locally advanced triple negative (hormone receptor negative and HER2 negative) breast cancer

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Cancer Chemother Pharmacol. 2008 Sep;62(4):667-72. Epub 2007 Dec 7.
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Tailored
preoperative treatment of locally advanced triple negative (hormone
receptor negative and HER2 negative) breast cancer with epirubicin,
cisplatin, and infusional fluorouracil followed by weekly paclitaxel.

Torrisi R, Balduzzi A, Ghisini R, Rocca A, Bottiglieri L, Giovanardi F, Veronesi P, Luini A, Orlando L, Viale G, Goldhirsch A, Colleoni M.Research
Unit of Medical Senology, European Institute of Oncology, via
Ripamonti, 435 20141, Milan, Italy.

BACKGROUND:
No specific treatment guidelines are available for triple-negative
breast cancers, defined by a lack of expression of estrogen (ER),
progesterone (PgR), and HER2 receptors.
PATIENTS AND METHODS: We
investigated in patients with T2-T3 N0-3 ER, PgR <10% and HER2
negative breast cancers the activity both in terms of pathological
(pCR) and objective responses of four courses of cisplatin containing
chemotherapy (ECF, epirubicin, cisplatin, and fluorouracil as
continuous infusion) followed by three courses of weekly paclitaxel.
Adjuvant metronomic chemotherapy including cyclophosphamide and
methotrexate for 4-6 months was administered.
RESULTS: Thirty patients
are evaluable. Median age was 41 years (28-64 years). Twenty-three of
25 evaluable tumors stained positively for epidermal growth factor
receptor. An objective response, either complete and partial, was
observed in 26 patients (86, 95% CI 69.3-96.2%). and a pCR was obtained
in 12 patients (40, 95% CI 22.7-59.4%). Two patients progressed during
paclitaxel. Negative axillary nodes were found in 80% (95% CI
61.4-92.3%) of patients at surgery. Twenty-six patients (86, 95% CI
61.4-92.3%) underwent breast conserving surgery. Grade >2
non-hematological toxicity was observed in three and two patients
during ECF and paclitaxel, respectively. The 2-year disease free
survival (DFS) was 87.5% (95% CI 74.7-100%). No significant correlation
was observed between EGFR staining and either pCR or DFS.
CONCLUSIONS:
Preoperative cisplatin containing chemotherapy followed by paclitaxel
induced an high pCR rate in a population of triple-negative breast
cancer. The impact of this schedule on long-term outcome should be
investigated in larger series.