RESUMEN
INTRODUCTION: Oligometastatic breast cancer incidence is recently increasing thanks to screening and imaging improvements. Unlike patients with metastatic disease, a small number of oligometastatic patients may expect a definitive remission, in case of aggressive management performed with intent to cure. We report the atypical evolution of an oligometastatic breast cancer patient, who lately relapsed with a different Her2 status. RESULTS: A 46 year old women was treated for an infiltrating duct breast carcinoma, initially diagnosed with oligometastases and an Her2- negative status. Treatments were performed in intent to cure but the patient relapsed 5 years later with a solitary Her2-positive liver metastasis. The aggressive local and systemic (using an anti- Her2 targeted therapy) management induced a still complete remission at last follow-up. CONCLUSION: Prognosis of breast oligometastatic cancer is unpredictable, but an aggressive with intent-to-cure management may bring benefits to patients. However very rare, the switch of Her2 status between initial diagnosis and relapse highlights tumor heterogeneity, and the fact that a cell population featuring targetable characteristics may appear due to anticancer drug induced-cell selection.
INTRODUCTION: L'incidence des cancers du sein oligométastatiques est en augmentation, grâce aux progrès du dépistage et de l'imagerie. Au contraire de la maladie métastatique, un faible pourcentage de ces patientes peut espérer une guérison définitive en cas de prise en charge menée en intention curative sur toutes les cibles. Nous rapportons le cas de l'évolution atypique d'une patiente oligométastatique, avec une récidive tardive d'un cancer du sein, aux caractéristiques génétiques transformées. Résultats : Une patiente de 46 ans a été prise en charge initialement pour un adénocarcinome mammaire d'emblée oligo-métastatique ne surexprimant pas Her2. Après un traitement à visée curative, la patiente a rechuté 5 ans plus tard avec une métastase hépatique unique, surexprimant Her2. La prise en charge locale curative et systémique avec une thérapie ciblant Her2 a permis la rémission complète persistante après 3 ans de suivi. CONCLUSION: Le pronostic de la maladie oligométastatique du sein doit être abordé avec prudence, mais un traitement réalisé en intention curative peut apporter un bénéfice aux patientes. Le changement de statut Her2 entre le diagnostic primitif et la récidive -fait très rare- souligne l'hétérogénéité de la population tumorale, dont une fraction présentant des caractéristiques génétiques particulières peut émerger, sous la pression de sélection des drogues anticancéreuses.
Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/terapia , Adenocarcinoma/genética , Adenocarcinoma/patología , Adenocarcinoma/terapia , Neoplasias de la Mama/genética , Carcinoma Ductal de Mama/genética , Femenino , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Persona de Mediana Edad , Terapia Molecular Dirigida , Metástasis de la Neoplasia , Receptor ErbB-2/antagonistas & inhibidores , Receptor ErbB-2/genética , Inducción de RemisiónRESUMEN
Systemic therapy for triple negative breast cancer (TNBC) is mostly based upon chemotherapy. Epithelial Growth Factor Receptor (EGFR) is overexpressed in around 50% of TNBC and may play a role in its pathogenesis. Consequently, we performed a multicentric pilot Phase II neoadjuvant trial of cetuximab (anti-EGFR antibody) combined with docetaxel for patients with operable, Stage II-III TNBC. Therapy consisted of weekly cetuximab (first infusion: 400 mg/m(2), then 250 mg/m(2)) combined with six cycles of docetaxel (T: 100 mg/m(2)) q.3 weeks. Subsequently, all patients underwent surgery. The primary endpoint was pathological complete response (pCR) while clinical response, toxicity and ancillary studies were secondary endpoints. Paraffin-embedded and frozen tumor samples were systematically collected in order to identify predictive biomarkers of efficacy and resistance. From a total of 35 accrued patients, 25 were assessable for pathologic response. The pCR rate was 24% [95% CI: 7.3-40.7]. Complete clinical response rate (cCR) was observed in 22% of cases. Conservative surgery was performed in 75% of patients. Toxicity, mostly cutaneous and hematologic, was manageable. The pre-therapy ratio between CD8+ and FOXP3+ tumor-infiltrating lymphocytes equal or higher than 2.75 was predictive of pCR: 43% versus 0%, p = 0.047. Cetuximab in combination with docetaxel displays a modest activity, but acceptable toxicity as neoadjuvant therapy of operable TNBC. Similarly to previous observations using panitumumab, another anti-EGFR antibody, the immune component of the tumor microenvironment may play an important role in predicting TNBC response to the neoadjuvant therapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma Ductal de Mama/tratamiento farmacológico , Terapia Neoadyuvante/métodos , Neoplasias de la Mama Triple Negativas/tratamiento farmacológico , Adulto , Anciano , Carcinoma Ductal de Mama/cirugía , Cetuximab/administración & dosificación , Cetuximab/efectos adversos , Quimioterapia Adyuvante , Terapia Combinada , Docetaxel , Femenino , Humanos , Mastectomía , Persona de Mediana Edad , Proyectos Piloto , Taxoides/administración & dosificación , Taxoides/efectos adversos , Neoplasias de la Mama Triple Negativas/cirugíaRESUMEN
BACKGROUND: Metastatic breast cancer chemotherapy in the elderly is considered effective in carefully selected patients, but there is little data regarding its effect in vulnerable patients. METHODS: We evaluated tumour response (primary endpoint), feasibility and outcomes after six courses of an adapted dose of pegylated liposomal doxorubicin (PLD) (40 mg/m(2) every 28 days) as first-line chemotherapy for hormone-resistant MBC. RESULTS: Of 60 patients >70 years (median 77 years), 15% had performance status ≥2 and 73% had visceral metastases. Geriatric assessment included: ≥2 comorbidities, 42%; ≥1 deficiency in Activities of Daily Living (ADL), 10% and Instrumental ADL (IADL), 82%; living in residential homes, 12%; albumin <35 g/L, 17%; body mass index (BMI) <21, 20%; depression, 17%; and lymphocytes ≤1 × 10(3)/mm(3), 27%. Complete response, partial response and stable disease were observed in 5%, 15% and 60%, respectively, but only 48% completed six cycles. Treatment discontinuations were mostly due to disease progression (18%) and non-haematological (NH) toxicities (22%). Eight patients died during treatment (three possibly related to PLD), and 15 had unplanned hospital admissions. Exploratory analyses to identify geriatric covariates associated with treatment outcomes revealed severe haematological toxicities significantly correlated with lymphocytes ≤1 × 10(3)/mm(3). NH toxicities correlated with age ≥80 years and living in residential homes. Progression-free survival (median 6.1 months) decreased with age, deficiency in IADL, cardiac dysfunction and living in residential homes. Overall survival (median 15.7 months) also decreased with living in residential homes. CONCLUSION: Despite manageable haematological toxicities and expected response rates, PLD feasibility was poor in unselected elderly patients.
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Antibióticos Antineoplásicos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Doxorrubicina/análogos & derivados , Polietilenglicoles/uso terapéutico , Actividades Cotidianas , Factores de Edad , Anciano , Anciano de 80 o más Años , Antibióticos Antineoplásicos/administración & dosificación , Antibióticos Antineoplásicos/efectos adversos , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/secundario , Supervivencia sin Enfermedad , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Doxorrubicina/uso terapéutico , Esquema de Medicación , Femenino , Francia , Evaluación Geriátrica , Cardiopatías/complicaciones , Hogares para Ancianos , Humanos , Estimación de Kaplan-Meier , Análisis Multivariante , Casas de Salud , Oportunidad Relativa , Polietilenglicoles/administración & dosificación , Polietilenglicoles/efectos adversos , Modelos de Riesgos Proporcionales , Medición de Riesgo , Factores de Riesgo , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del TratamientoRESUMEN
Normofractionated radiotherapy is standard for adjuvant management of patients treated with breast conservative surgery for breast cancer. However, many elderly patients are not eligible to such strategy, either because of concurrent diseases, or because the tumor is inoperable. Several protocols of exclusive radiotherapy have been reported in the literature, frequently using hypofractionated radiotherapy and endocrine therapy. We report a case of a patient treated with exclusive endocrine and radiotherapy and address the state of the art on hypofractionated schemes for the management of elderly breast cancer patients. While hypofractionated radiotherapy does not compromise the oncologic or cosmetic outcome, there is no prospective data that assesses the place of radiotherapy for the exclusive treatment of elderly patients. This strategy should be further assessed in clinical randomized trial.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/radioterapia , Hormonas/uso terapéutico , Anciano de 80 o más Años , Terapia Combinada , Femenino , HumanosRESUMEN
Oral chemotherapy is increasingly used in oncology. Poor adherence, that is, non-respect of medical advice about taking the therapy and surveillance of adverse effects, is the main risk associated with this administration route. Poor adherence may be explained by non-adherence by the patient to the treatment, misunderstanding the advice or it could also reflect the poor adaptation of the healthcare team to a new administration route. Here we report the results from a qualitative study that aimed to describe and understand existing practice for capecitabine, an oral chemotherapy, which is used for the treatment of metastatic breast and colon cancer. We interviewed 42 patients who were receiving oral capecitabine in groups and individually as well as 10 prescribers. This study was carried out in two specialist cancer centres. The results showed a wide diversity in the prescribers' practices, who make decisions based on their experience of practice guidelines for intravenous chemotherapies. Although the results for the patients do not suggest deliberate non-adherence, they show poor observance of the dose schedule. The most important result of this study is the patient's inability to identify and to report important signs of harmful toxicity.
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Antineoplásicos/administración & dosificación , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias del Colon/tratamiento farmacológico , Desoxicitidina/análogos & derivados , Fluorouracilo/análogos & derivados , Cumplimiento de la Medicación , Administración Oral , Anciano , Anciano de 80 o más Años , Capecitabina , Desoxicitidina/administración & dosificación , Esquema de Medicación , Femenino , Fluorouracilo/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Investigación Cualitativa , Factores de RiesgoRESUMEN
The chemotherapy of the metastatic breast cancer is characterized by the diversity of the treatment protocols and the utilisation of new expensive molecules posing the double problem of outcomes for the patients and financial effects for the hospitals. This survey describes the different chemotherapy treatments prescribed in the metastatic breast cancer and the direct costs supported by the hospitals according to the patient survival time. A cohort of 371 patients treated for a metastatic breast cancer was followed in three hospitals of the Rhone-Alpes region between 2001 and 2006. The detail of their different antineoplasic treatments, as well as the purchase cost of the drugs and their cost of hospital administration, the cost of the other hospital stays are presented in relation with the survival. The median survival time (35,8 months; CI 95%: [31.7-39.1]) since the first metastasis does not differ significantly according to the hospital. Ninety-three different chemotherapy protocols are observed combining from one to five molecules. Thirty-two different molecules are identified. In first line treatment, there is a significant difference in the use of the new molecules according to hospital (Chi(2) test; P < 10(-3)). The average cost of a chemotherapy treatment is 3,919 euro (+/- 8,069 euro), the higher cost is observed for trastuzumab (23,443 euro). The average time period before the beginning of a new chemotherapy line is 212 days (+/- 237 days) and the mean cost of hospital stay during this period is 3,903 euro (+/- 4,097 euro). If no impact of the chemotherapy treatment strategy is observed on the survival time of the patient, it is the opposite for the hospital treatment cost. These results are asking for a better control system of the authorization procedure of new molecules marketing and the harmonization of the practices.
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Protocolos de Quimioterapia Combinada Antineoplásica/economía , Neoplasias de la Mama/tratamiento farmacológico , Costos de los Medicamentos , Antineoplásicos Hormonales/economía , Antineoplásicos Hormonales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Óseas/mortalidad , Neoplasias Óseas/secundario , Neoplasias de la Mama/economía , Neoplasias de la Mama/mortalidad , Instituciones Oncológicas/economía , Distribución de Chi-Cuadrado , Costos Directos de Servicios , Femenino , Francia/epidemiología , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Persona de Mediana Edad , Cuidados Paliativos/economía , Análisis de SupervivenciaRESUMEN
Shared decision-making is based on the idea of an enlightened participation of the patient to the therapeutic decision process, especially when the ratio between risks and benefits of treatment options is uncertain. The physician owes to ponder the advantages and the inconveniences of chemotherapy, which can be enlightened by a discussion with the patient. Thus, neither shared decision-making nor decision tools are currently used in France. Our aim is to evaluate the variables that step in the therapeutic choice of French physicians concerning the adjuvant chemotherapy prescription in breast cancer. We focus on the impact of different medical cultures on decision processes and shared decision-making conceptions. A socio-anthropological study is carried out with the participation of six French medical centre. First results show the influence of local specificities, professional groups and individual sociocultural background of physicians.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Cultura , Toma de Decisiones , Oncología Médica , Participación del Paciente , Neoplasias de la Mama/etnología , Quimioterapia Adyuvante , Consenso , Técnicas de Apoyo para la Decisión , Femenino , Francia , Humanos , Práctica Profesional , Medición de RiesgoRESUMEN
Patients with cancer frequently suffer a deteriorated quality of life and this is an important factor in the therapeutic decision. The correlation between quality of life and malnutrition seems obvious and bidirectional. The aim of our study was to describe the global quality of life and its various dimensions in patients with cancer, as a function of the nutritional status. A transversal observational study was performed in wards in hospitals in Clermont-Ferrand and Saint Etienne on 907 patients. The EORTC questionnaire, QLQ-C30, was used to assess the quality of life. The mean global quality of life score was 48.8 for patients who had a weight loss of more than 10% since the beginning of their illness, compared with 62.8 for the other patients (p<0.001). A significant association with weight was observed for the main dimensions of the quality of life: physical, functional, cognitive, social, fatigue, nausea, pain, loss of appetite, constipation and diarrhoea. This strong relation between quality of life and weight loss shows the importance of dietary management in patients with cancer.
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Desnutrición/etiología , Neoplasias/complicaciones , Estado Nutricional , Calidad de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/fisiopatología , Neoplasias/psicología , Pérdida de PesoRESUMEN
BACKGROUND: In routine practice, the evaluation of the nutritional status of patients with cancer is not always performed although there is frequent modification as disease progresses. The validated screening and evaluation tools currently available are time-consuming and costly. In this study we analysed factors that could be used to identify patients likely to need nutritional surveillance or intervention. PATIENTS AND METHODS: A cross-sectional survey was carried out for 2 weeks in June 2006 on 477 patients with cancer. RESULTS: 30.2% of the patients had lost more than 10% of their body weight since the start of the illness. After adjustment, the factors significantly associated with weight loss were: depressive state (OR = 3.49; P = 0.002), digestive or ENT tumours (OR = 3.20; P = <0.001), chemotherapy (OR = 2.66; P = 0.011), male gender (OR = 2.30; P = 0.001) and professional status (OR = 2.08; P = 0.02). Using a logistic model, we calculated the risk of weight loss as a function of the presence of the identified predictive factors. CONCLUSION: We report a simple screening tool, which will not replace the available evaluation methods but will enable targeting of the patients most likely, after a specific evaluation, to benefit from nutritional intervention. This remains to be validated in further prospective studies.
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Desnutrición/diagnóstico , Desnutrición/epidemiología , Neoplasias/epidemiología , Apoyo Nutricional/métodos , Síndrome Debilitante/epidemiología , Distribución por Edad , Anciano , Análisis de Varianza , Causalidad , Comorbilidad , Estudios Transversales , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Desnutrición/terapia , Tamizaje Masivo/métodos , Persona de Mediana Edad , Neoplasias/diagnóstico , Neoplasias/terapia , Evaluación Nutricional , Estado Nutricional , Prevalencia , Curva ROC , Medición de Riesgo , Distribución por Sexo , Síndrome Debilitante/fisiopatología , Pérdida de PesoAsunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antineoplásicos/uso terapéutico , Neoplasias de la Mama/economía , Anticuerpos Monoclonales Humanizados , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/secundario , Análisis Costo-Beneficio , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Receptor ErbB-2/metabolismo , Trastuzumab , Resultado del TratamientoRESUMEN
BACKGROUND: Data from prospective clinical trials are needed to better define standards of care in elderly patients with advanced ovarian carcinoma and to demonstrate the interest of Comprehensive Geriatric Assessment (CGA) in this fragile and heterogeneous population. PATIENTS AND METHODS: From July 1998 to October 2000, 83 advanced ovarian carcinoma patients >70 years old received carboplatin AUC 5 and cyclophosphamide 600 mg/m2, on day 1 of six 28-day cycles. The clinical and biological geriatric covariates prospectively studied were: comorbidities, comedications, cognitive functions (Mini-Mental test), nutritional status and autonomy. RESULTS: Patient characteristics were: median age 76 years, serous histology (73%), FIGO stage III (75%), optimal initial surgery (21%) and performance status (PS) > or =2 (44%). Sixty patients (72%) received six chemotherapy cycles without severe toxicity (STox) or tumor progression. Multivariate analysis retained three factors as independent predictors of STox: symptoms of depression at baseline (P = 0.006), dependence (P = 0.048) and PS > or =2 (P = 0.026). Independent prognostic factors identified for overall survival (Cox model) were depression (P = 0.003), FIGO stage IV (P = 0.007) and more than six different comedications per day (P = 0.043). CONCLUSION: CGA could predict STox and overall survival of elderly advanced ovarian carcinoma patients.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Evaluación Geriátrica , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/mortalidad , Anciano , Anciano de 80 o más Años , Carboplatino/administración & dosificación , Carcinoma Papilar/tratamiento farmacológico , Carcinoma Papilar/mortalidad , Carcinoma Papilar/secundario , Ciclofosfamida/administración & dosificación , Cistadenocarcinoma Seroso/tratamiento farmacológico , Cistadenocarcinoma Seroso/mortalidad , Cistadenocarcinoma Seroso/secundario , Progresión de la Enfermedad , Femenino , Humanos , Dosis Máxima Tolerada , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/mortalidad , Neoplasias Ováricas/patología , Pronóstico , Estudios Prospectivos , Tasa de SupervivenciaRESUMEN
Desmoplastic small round-cell tumors in young adults were first described in 1989. They may be revealed by an abdominal mass or a peritoneal carcinomatosis. The diagnosis and the initial treatment are based on debulking surgery. Chemotherapy using doxorubicin, ifosfamide, etoposide and cisplatin can then be proposed. Despite some initial chemosensitivity, prognosis remains poor.
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Neoplasias Abdominales/diagnóstico , Neoplasias Abdominales/cirugía , Carcinoma de Células Pequeñas/diagnóstico , Carcinoma de Células Pequeñas/cirugía , Carcinoma/diagnóstico , Carcinoma/cirugía , Neoplasias Abdominales/complicaciones , Dolor Abdominal/etiología , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/complicaciones , Carcinoma de Células Pequeñas/complicaciones , Quimioterapia Adyuvante , Cisplatino/administración & dosificación , Doxorrubicina/administración & dosificación , Etopósido/administración & dosificación , Resultado Fatal , Humanos , Ifosfamida/administración & dosificación , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: Platinum compounds are the most active drugs in ovarian cancer treatment; cisplatin and carboplatin demonstrated similar efficacies but different toxicity profiles. Paclitaxel combined with cisplatin as first-line treatment improved overall survival when compared to a cisplatin-cyclophosphamide combination, but generated higher rates of neutropenia, febrile neutropenia and neurotoxicity. The paclitaxel-carboplatin combination may be better tolerated than cisplatin-paclitaxel. DESIGN: The objective of the present study was to assess the efficacy and safety of the combination of paclitaxel and carboplatin in previously treated advanced ovarian cancer patients. PATIENTS AND METHODS: During or after platinum-based chemotherapy, 73 patients with progressive advanced epithelial ovarian carcinoma were enrolled to receive every four weeks a three-hour infusion of paclitaxel 175 mg/m2 followed by a 30-minute carboplatin infusion. The carboplatin dose was calculated to obtain the recommended area concentration-versus-time under the curve of 5 mg x ml-1 x min. RESULTS: Toxicity and response could be evaluated for 72 and 62 patients, respectively. Eleven complete and 15 partial responses gave an overall response rate of 42% (95% CI: 30%-54%). Response rates for platinum-refractory patients and those with early (> or = 3 and < 12 months) and late (> 12 months) relapses were 24%, 33% and 70%, respectively. The respective median response duration, the median progression-free survival and median overall survival were 8, 6 and 14 months. Myelosuppression was the most frequent and severe toxicity. Grade 3 and 4 neutropenia occurred, respectively in 30% and 23% of the cycles; 6% of the cycles benefited from medullary growth factors. Only one episode of febrile neutropenia was observed. Grade 3 and 4 thrombocytopenia occurred, respectively during 3% and 1% of the cycles. Alopecia was frequent. Transient peripheral neuropathy developed in 47% of patients but was severe in only one patient. One early death was attributed to progressive disease and possibly to therapy. CONCLUSION: This combined paclitaxel-carboplatin therapy is effective and can be safely administered to ovarian cancer patients who relapse after one or two regimens of platinum-based chemotherapy.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Ováricas/tratamiento farmacológico , Adolescente , Anciano , Carboplatino/administración & dosificación , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/mortalidad , Paclitaxel/administración & dosificación , Retratamiento , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
The French Groupe des Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) conducted a multicenter phase II study of carboplatin and paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) to evaluate the efficacy and side effects of this combination in pretreated advanced ovarian cancer. Patients with progressive ovarian carcinoma during or after platinum-based chemotherapy received paclitaxel 175 mg/m2 intravenously over 3 hours followed by intravenous carboplatin over 30 minutes every 4 weeks. The dose of carboplatin was calculated using a projected area under the concentration-time curve of 5 mg/mL x min. Of the 50 patients entered, 50 were evaluable for toxicity and 42 for response. There were eight complete and 10 partial responses, for an overall response rate of 43% (95% confidence interval, 28% to 56%). Overall response rates in platinum refractory patients and in those with early (> or = 3 and < 12 months) and late (> or = 12 months) relapse was 28%, 33%, and 71%, respectively. Median response duration, progression-free survival, and overall survivals were 8, 6, and 14 months, respectively. The most frequent and severe toxicity was myelosuppression. Grades 3 and 4 neutropenia occurred in 30% and 23% of cycles, and granulocyte colony-stimulating factor was administered in 6%. Only one case of neutropenic fever was observed. Grades 3 and 4 thrombocytopenia occurred in 3% and 1% of cycles, respectively. Alopecia and moderate nausea or vomiting were frequent. Transitory peripheral neuropathy was present in 45% of patients but was severe in only one patient. One early death was observed due to progressive disease and possibly to therapy. The combination of paclitaxel 175 mg/m2 as a 3-hour infusion and carboplatin dosed to an area under the concentration-time curve of 5 is an effective therapy in patients previously treated with platinum-based chemotherapy and may be administered safely to outpatients who relapse after one or two lines of chemotherapy.
Asunto(s)
Antineoplásicos Fitogénicos/administración & dosificación , Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carboplatino/administración & dosificación , Carcinoma/tratamiento farmacológico , Neoplasias Ováricas/tratamiento farmacológico , Paclitaxel/administración & dosificación , Adolescente , Adulto , Anciano , Alopecia/inducido químicamente , Antineoplásicos/efectos adversos , Antineoplásicos Fitogénicos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Área Bajo la Curva , Carboplatino/efectos adversos , Carcinoma/patología , Cisplatino/administración & dosificación , Intervalos de Confianza , Progresión de la Enfermedad , Femenino , Francia , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Humanos , Inyecciones Intravenosas , Persona de Mediana Edad , Náusea/inducido químicamente , Recurrencia Local de Neoplasia/tratamiento farmacológico , Estadificación de Neoplasias , Neutropenia/inducido químicamente , Neoplasias Ováricas/patología , Paclitaxel/efectos adversos , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Inducción de Remisión , Seguridad , Tasa de Supervivencia , Trombocitopenia/inducido químicamente , Resultado del TratamientoRESUMEN
In 1986 the true benefit of adjuvant medical treatment in postmenopausal patients with pathological node-positive breast adenocarcinoma was still controversial. The French Adjuvant Study Group (FASG) initiated a randomised trial to elucidate the respective roles of adjuvant chemo-and/or hormonotherapy in this group of patients. Of the 776 patients who have been included between 1986 and 1990, 741 were fully eligible for evaluation. Inclusion criteria were postmenopausal patients aged between 50 and 70 years with adenocarcinoma of the breast, positive pathological nodes and no distant metastasis. Patients were randomised to 1 of 4 treatment arms: Group A (n = 192) received tamoxifen 30 mg/day orally for 3 years; Group B (n = 183) received FEC 50 (fluorouracil 500 mg/m2, epirubicin 50 mg/m2 plus cyclophosphamide 500 mg/m2) for 6 cycles; Group C (n = 182) received tamoxifen 30 mg/day orally for 3 years plus FEC 50 for 6 cycles; Group D (n = 184) received no medical adjuvant treatment. Surgery was either modified radical mastectomy (n = 363) or tumorectomy (n = 378), and postoperative irradiation was given to all patients. All major prognostic factors were well balanced between the 4 patient groups. Toxicity was evaluated in 348 patients in Groups B and C who received a total of 1983 chemotherapy cycles. Median epirubicin dose intensity (mg/m2/week) was 15.8 in Group B and 15.7 in Group C. Grade 3 to 4 neutropenia was observed in 4.7% of cycles for Group B and 3.7% for Group C. Grade 3 to 4 nausea/vomiting were seen in 18% of treatment cycles in Group B and 15% in Group C.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Posmenopausia , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/cirugía , Ciclofosfamida/administración & dosificación , Ciclofosfamida/efectos adversos , Esquema de Medicación , Epirrubicina/administración & dosificación , Epirrubicina/efectos adversos , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Estudios de Seguimiento , Humanos , Metástasis Linfática , Persona de Mediana Edad , Tasa de Supervivencia , Tamoxifeno/administración & dosificación , Tamoxifeno/efectos adversos , Resultado del TratamientoRESUMEN
Anthracyclines containing regimen are widely used in advanced breast cancer. The response to first line chemotherapy varies according to many individual factors and the theoretical response to a given protocol cannot predict the response of a patient. A randomized clinical trial (ERASME) was initiated in order to evaluate the more appropriate first line chemotherapy scheme in advanced breast cancer. Prognostic factors were included in a multiple logistic regression to explain the response after the first 3 chemotherapy courses (monthly FEC). Three factors were found to be statistically significant: adjuvant hormonotherapy, loco-regional metastases, adjuvant adriamycin containing regimen (pejorative prognostic factor). By combining these factors, this statistical model enables us to predict a response rate to a first line chemotherapy from 27 to 87%. Such a model can be taken into account in a decision-making procedure of first line chemotherapy in advanced breast cancer.