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12-10-2004, 08:38 PM
http://www.abstracts2view.com/sabcs/sessionindex.php
[1110] High pathological complete remission rate following neoadjuvant taxane, carboplatin and trastuzumab therapy after doxorubicin and cyclophosphamide in Her-2 positive breast cancer patients.
Mehta RS, Schubbert T, Hsiang D, Su L, Carpenter P, Holcombe R, Butler J, Baick C. Univeristy of California, Irvine, Orange, CA
Background: A pathological complete remission (pCR), a surrogate of improved survival, is achieved in a minority of breast cancer (BC) patients after neoadjuvant doxorubicin and cyclophosphamide (AC). Recently, targeted therapy using a taxane, carboplatin and trastuzumab (TCH) regimen has shown improved clinical outcome in patients with Her-2 positive stage IV BC. We hypothesized that targeted therapy with TCH will synergize with or overcome resistance to AC in the neoadjuvant setting. Materials and Method: A retrospective review of 8 consecutive locally advanced (stage: 4, IIIA; 3, IIIB; 1, IV), Her-2 positive (IHC 3+) BC patients enrolled into our IRB approved imaging studies was performed. Pretreatment average tumor size was 6.8 cm. All patients received 2 to 4 cycles of AC. The first 2 patients received a taxane following AC prior to 4 cycles of 3-weekly TCH regimen. The next 6 patients received dose dense AC with growth factor support as initial treatment followed by weekly TCH (T-80mg/m2, C-AUC of 2, H-4mg/kg then 2mg/kg, 14 average doses). At the end of AC-TCH therapy, patients had definitive surgery. Results: Seven of 8 patients demonstrated pCR following TCH even though they had variable responses (3-major clinical response; 4-no response; 1-relapse) to AC. Only 1 of 8 patients had a 3 mm residual invasive carcinoma in the biopsy scar. Moreover, 7 of 7 patients with palpable lymph nodes demonstrated no residual cancer. Seven patients remain progression free and all 8 patients are alive at a median follow up of 14 months (range 6-22) from the time of diagnosis. None of the patients had clinical cardiac dysfunction or neutropenic fever. Discussion: Our results indicate that AC followed by a short course of TCH induces a high rate of pCR in Her-2 positive patients. Given this high pCR rate, we speculate that the AC-TCH sequential regimen targets both topoisomerase II amplified and deleted clones, respectively, in Her-2 positive BC patients. Absence of clinical cardiac dysfunction in our patients suggests relative safety of sequential use of AC and TCH.
Wednesday, December 8, 2004 4:30 PM
Late Acceptances and Rescheduled Posters (4:30 PM-7:00 PM)
[1110] High pathological complete remission rate following neoadjuvant taxane, carboplatin and trastuzumab therapy after doxorubicin and cyclophosphamide in Her-2 positive breast cancer patients.
Mehta RS, Schubbert T, Hsiang D, Su L, Carpenter P, Holcombe R, Butler J, Baick C. Univeristy of California, Irvine, Orange, CA
Background: A pathological complete remission (pCR), a surrogate of improved survival, is achieved in a minority of breast cancer (BC) patients after neoadjuvant doxorubicin and cyclophosphamide (AC). Recently, targeted therapy using a taxane, carboplatin and trastuzumab (TCH) regimen has shown improved clinical outcome in patients with Her-2 positive stage IV BC. We hypothesized that targeted therapy with TCH will synergize with or overcome resistance to AC in the neoadjuvant setting. Materials and Method: A retrospective review of 8 consecutive locally advanced (stage: 4, IIIA; 3, IIIB; 1, IV), Her-2 positive (IHC 3+) BC patients enrolled into our IRB approved imaging studies was performed. Pretreatment average tumor size was 6.8 cm. All patients received 2 to 4 cycles of AC. The first 2 patients received a taxane following AC prior to 4 cycles of 3-weekly TCH regimen. The next 6 patients received dose dense AC with growth factor support as initial treatment followed by weekly TCH (T-80mg/m2, C-AUC of 2, H-4mg/kg then 2mg/kg, 14 average doses). At the end of AC-TCH therapy, patients had definitive surgery. Results: Seven of 8 patients demonstrated pCR following TCH even though they had variable responses (3-major clinical response; 4-no response; 1-relapse) to AC. Only 1 of 8 patients had a 3 mm residual invasive carcinoma in the biopsy scar. Moreover, 7 of 7 patients with palpable lymph nodes demonstrated no residual cancer. Seven patients remain progression free and all 8 patients are alive at a median follow up of 14 months (range 6-22) from the time of diagnosis. None of the patients had clinical cardiac dysfunction or neutropenic fever. Discussion: Our results indicate that AC followed by a short course of TCH induces a high rate of pCR in Her-2 positive patients. Given this high pCR rate, we speculate that the AC-TCH sequential regimen targets both topoisomerase II amplified and deleted clones, respectively, in Her-2 positive BC patients. Absence of clinical cardiac dysfunction in our patients suggests relative safety of sequential use of AC and TCH.
Wednesday, December 8, 2004 4:30 PM
Late Acceptances and Rescheduled Posters (4:30 PM-7:00 PM)