Department of Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
J Breast Cancer. 2011 Jun;14(2):129-34. doi: 10.4048/jbc.2011.14.2.129. Epub 2011 Jun 18.
This study was performed to compare the therapeutic efficacy and toxicity of doxorubicin plus docetaxel neoadjuvant chemotherapy (NC) with doxorubicin plus vinorelbine NC.
Fifty-three patients underwent 4 cycles of NC consisted of intravenous injection of doxorubicin (50 mg/m(2)) plus docetaxel (75 mg/m(2)) administered every 3 weeks (AD), while 49 patients underwent 4 cycles of NC consisted of intravenous injection of doxorubicin (50 mg/m(2)) and vinorelbine (25 mg/m(2)) administered every 3 weeks (AN). Response rate and treatment-related toxicities were analyzed by administered chemotherapeutics. Response to NC was also analyzed according to clinicobiological characteristics of the primary tumors.
Clinical response was observed in 66% with AN and 81.6% with AD chemotherapy. A complete pathologic response (pCR) was confirmed in 6 patients (11.3%) with AN and in 7 patients (14.3%) with AD after the surgery. Response rate was significantly higher in AD compared with AN (p=0.038), but there was no significant difference between the two group regard to pCR rate. Breast conserving surgery (BCS) was performed in 35.8% of AN group, whereas 20 patients (40.8%) of AD group underwent BCS. The patients with HER2-amplified tumor showed significantly increased response to both types of NC. Pathologic complete response was confirmed in 9 (39.1%) out of 23 HER2-amplified tumors, whereas only 4 (5.1%) of 79 HER2-nonamplified tumors showed pathologic complete response. Febrile neutropenia occurred in 22.6% of total 212 cycles in AN and 38.8% of total 196 cycles in AD. Grade 3/4 neutropenia was observed in 39.6% in AN and 43.9% in AD. Grade 3 mucositis was observed in 26.4% with AN and in 40.8% with AD.
There was no significant increase of pCR by AD compared with AN. Long-term follow-up results of our study indicate that clinical outcome after NC was significantly associated with initial response to NC regardless of therapeutic regimens.
本研究旨在比较多柔比星联合多西他赛新辅助化疗（NC）与多柔比星联合长春瑞滨 NC 的疗效和毒性。
53 例患者接受 4 周期 NC，方案为静脉注射多柔比星（50mg/m²）联合多西他赛（75mg/m²），每 3 周 1 次（AD 组），49 例患者接受 4 周期 NC，方案为静脉注射多柔比星（50mg/m²）联合长春瑞滨（25mg/m²），每 3 周 1 次（AN 组）。通过给予的化疗药物分析缓解率和治疗相关毒性。根据原发性肿瘤的临床生物学特征分析 NC 的反应。
AN 组临床缓解率为 66%，AD 组为 81.6%。AN 组 6 例（11.3%）和 AD 组 7 例（14.3%）患者术后病理完全缓解（pCR）。AD 组缓解率明显高于 AN 组（p=0.038），但两组 pCR 率无显著差异。AN 组保乳手术（BCS）率为 35.8%，AD 组为 20 例（40.8%）。HER2 扩增肿瘤患者对两种类型的 NC 反应均显著增加。23 例 HER2 扩增肿瘤中病理完全缓解 9 例（39.1%），79 例 HER2 非扩增肿瘤中病理完全缓解仅 4 例（5.1%）。AN 组共 212 个周期中发热性中性粒细胞减少症发生率为 22.6%，AD 组共 196 个周期中发热性中性粒细胞减少症发生率为 38.8%。AN 组 39.6%、AD 组 43.9%患者出现 3/4 级中性粒细胞减少症。AN 组 26.4%、AD 组 40.8%患者出现 3 级粘膜炎。
AD 与 AN 相比，pCR 无显著增加。本研究的长期随访结果表明，NC 后的临床结果与 NC 初始反应显著相关，而与治疗方案无关。
