Breast conservation and prolonged chemotherapy for locally advanced breast cancer: The University of Michigan experience

Sofia D. Merajver, Barbara L. Weber, Robert Cody, Daowen Zhang, Myla Strawderman, Kathleen A. Calzone, Virginia LeClaire, Albert Levin, Jennifer Irani, Mark Halvie, David August, Max Wicha, Allen Lichter, Lori J. Pierce

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85 Scopus citations

Abstract

Purpose: To determine whether breast conservation and prolonged neoadjuvant chemotherapy have efficacy in locally advanced breast cancer (LABC), as measured by survival and rate of breast conservation. Materials and Methods: Eighty-nine patients with stage III disease were enrolled at the University of Michigan (UM) onto a prospective nonrandomized trial. Patients received nine 21-day cycles of neoadjuvant chemohormonal therapy that consisted of doxorubicin 30 mg/m2 and cyclophosphamide 750 mg/m2 intravenously on day 1, conjugated estrogens 0.625 mg orally twice daily on days 6 to 8, methotrexate 40 mg/m2 and fluorouracil 500 mg/m2 intravenously on day 8, and tamoxifen 10 mg orally twice daily on days 9 to 14. Patients with a negative biopsy received radiation only, while those with residual disease underwent mastectomy and postoperative radiotherapy. Eight more cycles of chemohormonal therapy were administered after local-regional therapy. Results: The clinical response rate to neoadjuvant therapy was 97%, 28% of patients had a complete pathologic response evaluated at biopsy. Five- year overall and disease-free survival probabilities were 54% and 44%, respectively. The median disease-free survival time was 2.4 years. The 5- year actuarial rates of local-regional control with local failure as only first failure were 82% and 78% following radiotherapy, and mastectomy and radiotherapy, respectively (P = .99). Conclusion: Prolonged neoadjuvant chemohormonal therapy and biopsy-driven local therapy have efficacy in LABC, with 28% of patients being candidates for breast conservation and a 5-year overall survival rate of 54%.

Original languageEnglish (US)
Pages (from-to)2873-2881
Number of pages9
JournalJournal of Clinical Oncology
Volume15
Issue number8
DOIs
StatePublished - Aug 1997

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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