A phase 2 study of sequential neoadjuvant chemotherapy with gemcitabine and doxorubicin followed by gemcitabine and cisplatin in patients with large or locally advanced operable breast cancer: results from long-term follow-up

• Published in: Breast cancer (Tokyo, Japan) Japan), 2013-10, Vol.20 (4), p.357-362
• Main Authors: Julka, Pramod K., Chacko, Raju T., Nag, Shona, Parshad, Rajinder, Nair, Aravindan, Koppiker, Chaitanyanand B., Xue, Fen Chao Richard, Barraclough, Helen, Dhindsa, Navreet, Seth, Anil, Majumdar, Anurita, Puri, Tarun
• Format: Article
• Language: English
• Subjects: Adjuvant treatment; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cancer; Cancer Research; Care and treatment; Chemotherapy, Adjuvant; Cisplatin - administration & dosage; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Doxorubicin - administration & dosage; Female; Follow-Up Studies; Genetic markers; Humans; Lumpectomy; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Oncology; Original Article; Prognosis; Surgery; Surgical Oncology; Survival Rate
• ISSN: 1340-6868; 1880-4233
• DOI: 10.1007/s12282-012-0343-4

Background Neoadjuvant chemotherapy (NACT) is being increasingly used for patients with large-size operable breast cancer. This phase 2 study of sequential NACT with gemcitabine and doxorubicin (Gem + Dox) followed by gemcitabine and cisplatin (Gem + Cis) was conducted in women with large or locally advanced breast cancer. The objectives were to evaluate the pathological complete response (pCR) rate, toxicity, pathological and genetic markers predicting response, the proportion of patients undergoing breast conservation surgery, progression-free survival (PFS) and overall survival (OS) after 5 years, and time to treatment failure (TtTF). In this manuscript, we report the long-term OS, PFS, and TtTF results. Methods Female patients aged at least 18 years with large T2 (at least 3 cm) or locally advanced (T3, T4, or N2) breast carcinoma were included. Treatment consisted of 4 cycles of Gem + Dox (gemcitabine 1,200 mg/m 2 on days 1 and 8 plus doxorubicin 60 mg/m 2 on day 1 of each 21-day cycle), followed by 4 cycles of Gem + Cis (gemcitabine 1,000 mg/m 2 on days 1 and 8 plus cisplatin 70 mg/m 2 on day 1 of each 21-day cycle), and then surgery. Results Sixty-five patients were enrolled. The pCR rate was 20%. The 5-year OS probability was 71% (95% CI 56–82%), and the 4-year PFS and TtTF probabilities were 63% (95% CI 48–74%) and 45% (95% CI 32–57%), respectively. Conclusions NACT with Gem + Dox followed by Gem + Cis was efficacious in patients with operable breast cancer.