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Japanese Journal of Clinical Oncology Advance Access originally published online on February 12, 2008
Japanese Journal of Clinical Oncology 2008 38(2):99-105; doi:10.1093/jjco/hym172
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© The Author (2008). Published by Oxford University Press. All rights reserved

High Pathologic Complete Response in HER 2-positive Locally Advanced Breast Cancer after Primary Systemic Chemotherapy with Weekly Docetaxel and Epirubicin

Shin-Cheh Chen1,, Hsien-Kun Chang2, Yung-Chang Lin2, Swei Hsueh3, Yun-Chung Cheung4, Wai-Man Leung5, Chien-Sheng Tsai5, Yung-Feng Lo1, Hsiu-Pei Tsai1, Shih-Che Shen1 and Miin-Fu Chen1

1 Department of Surgery, Chang Gung University Medical College, Taoyuan, Taiwan
2 Division of Medical Oncology, Chang Gung University Medical College, Taoyuan, Taiwan
3 Department of Pathology, Chang Gung University Medical College, Taoyuan, Taiwan
4 Department of Diagnostic Radiology, Chang Gung University Medical College, Taoyuan, Taiwan
5 Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University Medical College, Taoyuan, Taiwan

For reprints and all correspondence: Shin-Cheh Chen, Department of Surgery, Chang-Gung Memorial Hospital, 199, Tung-Hwa North Road, Taipei, Taiwan. E-mail: chensc{at}adm.cgmh.org.tw

Received May 8, 2007; accepted November 18, 2007

Background: To evaluate pathological complete response rate and to identify the predictor of response after primary systemic chemotherapy (PST) with weekly docetaxel and epirubicin for locally advanced breast cancer.

Methods: Sixty-three patients with locally advanced breast cancer received three cycles PST on day 1 and 8 of each 3-week cycle with epirubicin and docetaxel (epirubicin 45 mg/m2 intravenous bolus, docetaxel 35 mg/m2 in 100 ml normal saline infused 1 h), followed by surgery and adjuvant chemotherapy with cyclophosphamide, epirubicin and 5-fluorouracil. The pathological complete response was defined as no invasive carcinoma in breast and axillary nodes after PST.

Results: The median tumor sizes (by ultrasound) before and after PST were 6.2 and 2.5 cm, respectively. The negative estrogen receptor (ER) by immunochemical stain was found in 33 (52.4%) patients and HER-2/neu-overexpression in 12 (19.0%) patients. Clinical overall response rate (ORR) was 89% (95% confidence intervals (95% CI: 81–97), including 38% complete response (95% CI: 26–50), sonographical ORR was 97% (95% CI: 93–100). The pathological complete response were found in 11 patients (18%, 95% CI: 9–27), and 15(24%, 95% CI: 13–35) patients achieved breast only pathological complete response. Nine (27.3%) of thirty-three ER (–) patients and 5 (41.7%) of 12 HER2-positive patients achieved pathological complete response.

Conclusion: PST with weekly docetaxel and epirubicin were well-tolerated and very high pathological complete response rate was achieved in HER-2/neu-overexpression tumors.

Key Words: breast cancer • primary systemic chemotherapy • epirubicin • docetaxel • HER-2/neu


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