[MOL] Breast Cancer

["Lillian" <firefly@islc.net>]

 

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American Society of Clinical Oncology 35th Annual Meeting
Day 2 - May 16, 1999

New Tactics for Taxanes

Edith A. Perez, MD -- Writer: Michelle L. Plante, PharmD

Three small clinical trials on induction chemotherapy pointed to a potentially increasing role for taxanes in patients with resectable breast cancer.

Does Docetaxel Enhance Response to Primary Chemotherapy?

A European trial led by Dr. Eremin evaluated the role of docetaxel in primary chemotherapy for breast cancer. ^[1] The study aimed to determine the efficacy of sequential induction docetaxel in patients who did not respond to initial combination chemotherapy (CVAP; cyclophosphamide, vincristine, doxorubicin, prednisone) and to compare the efficacy of docetaxel with that of the CVAP regimen in patients who were initially responsive to such therapy.

The study was divided into 2 phases. In the first, all patients received 4 cycles of CVAP (cyclophosphamide 1000 mg/m2, vincristine 1.5 mg/m2 {max 2mg}, doxorubicin 50mg/m2, prednisone 40 mg/day x 5 days, every 21 days) and were evaluated for response. Based on the results, the investigators decided what phase 2 therapy the patient would receive. Patients who did not respond to the CVAP therapy received 4 cycles of docetaxel 100mg/m2. Patients who achieved a complete or partial response to the initial therapy were randomized to receive either 4 more cycles of the same chemotherapy or 4 cycles of docetaxel 100mg/m2.

To date, 148 patients with large (>/=3cm) or T₂N₃ tumors have been enrolled. Of those, 69% achieved an objective response to the first 4 cycles of CVAP. One-hundred thirty-three patients went on to phase 2 (93 patients with a response to the initial CAVP therapy to the randomization arm and 40 to the docetaxel arm). Of the patients randomized to either CVAP or docetaxel, the objective response rate was significantly improved when patients received docetaxel as shown in Table I.

Table I. Responses rates of patients who responded to initial CAVP therapy and then were randomized to CVAP or docetaxel therapy.

Response	CVAP n = 48	Docetaxel n = 45
Complete response	36%	60%
Partial response	31%	36%
Stable disease	29%	4%
Progressive disease	4%	0%
Overall response	67%	96%*

* p = 0.001