Inflammatory breast cancer outcome with epirubicin‐based induction and maintenance chemotherapy

• Published in: Cancer Vol. 107; no. 11; pp. 2535 - 2544
• Main Authors: Veyret, Corinne, Levy, Christelle, Chollet, Philippe, Merrouche, Yacine, Roche, Henri, Kerbrat, Pierre, Fumoleau, Pierre, Fargeot, Pierre, Clavere, Pierre, Chevallier, Bernard
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-12-2006
• Subjects: adjuvant chemotherapy; epirubicin; induction chemotherapy; inflammatory breast cancer; lenograstim
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.22227

BACKGROUND.
The authors evaluated the long‐term efficacy and side effects in patients with nonmetastatic, unilateral, inflammatory breast cancer (IBC) who received homogeneous treatment with intensive induction chemotherapy followed by a maintenance regimen.
METHODS.
One hundred twenty patients were randomized to receive high‐dose fluorouracil, epirubicin, and cyclophosphamide (FEC‐HD) (fluorouracil 750 mg/m2 on Days 1 to 4, epirubicin 35 mg/m2 on Days 2 to 4, and cyclophosphamide 400 mg/m2 on Days 2 to 4 for 4 cycles every 21 days) with or without lenograstim. Locoregional treatment consisted of surgery and/or radiotherapy. Maintenance chemotherapy was FEC 75 (fluorouracil 500 mg/m2, epirubicin 75 mg/m2, and cyclophosphamide 500 mg/m2 on Day 1 every 21 days for 4 cycles). No hormone treatment was allowed.
RESULTS.
The safety of the FEC‐HD regimen was described previously. Among 102 patients who underwent surgery, a pathologic complete response (pCR) was achieved by 23.5% of patients with breast tumors and by 31.4% of patients with involved axillary lymph nodes. The overall pCR rate was 14.7%. One hundred nine patients received FEC 75. After a median 10 years of follow‐up, the disease‐free survival (DFS) and overall survival (OS) rates were 35.7% and 41.2%, respectively. The median DFS was 39 months (95% confidence interval [95% CI], 25–53 months), and the median survival was 61 months (95% CI, 43–79 months). Five patients developed a temporary decrease in left ventricular ejection fraction without congestive heart failure. In the lenograstim group, 1 patient developed acute myeloblastic leukemia M2, and 1 patient developed myelodysplastic syndrome.
CONCLUSIONS.
FEC‐HD induction chemotherapy followed by FEC 75 maintenance regimen had moderate and acute long‐term toxicities and lead to high DFS and OS rates in patients with IBC. Cancer 2006. © 2006 American Cancer Society.
After 10 years of follow‐up, high‐dose epirubicin‐based induction chemotherapy followed by conventional epirubicin‐based adjuvant chemotherapy in 120 patients with inflammatory breast cancer resulted in a disease‐free survival rate of 35.7% and an overall survival rate of 41.2%.