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Gianni L, Eiermann W, Semiglazov V, Lluch A, Tjulandin S, Zambetti M, Moliterni A, Vazquez F, Byakhov MJ, Lichinitser M, Climent MA, Ciruelos E, Ojeda B, Mansutti M, Bozhok A, Magazzù D, Heinzmann D, Steinseifer J, Valagussa P, Baselga J. Neoadjuvant and adjuvant trastuzumab in patients with HER2-positive locally advanced breast cancer (NOAH): follow-up of a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet Oncol 2014; 15:640-7. [PMID: 24657003 DOI: 10.1016/s1470-2045(14)70080-4] [Citation(s) in RCA: 334] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND In our randomised, controlled, phase 3 trial NeOAdjuvant Herceptin (NOAH) trial in women with HER2-positive locally advanced or inflammatory breast cancer, neoadjuvant trastuzumab significantly improved pathological complete response rate and event-free survival. We report updated results from our primary analysis to establish the long-term benefit of trastuzumab-containing neoadjuvant therapy. METHODS We did this multicentre, open-label, randomised trial in women with HER2-positive locally advanced or inflammatory breast cancer. Participants were randomly assigned (1:1), by computer program with a minimisation technique, to receive neoadjuvant chemotherapy alone or with 1 year of trastuzumab (concurrently with neoadjuvant chemotherapy and continued after surgery). A parallel group with HER2-negative disease was included and received neoadjuvant chemotherapy alone. Our primary endpoint was event-free survival. Analysis was by intention to treat. This study is registered at www.controlled-trials.com, ISRCTN86043495. FINDINGS Between June 20, 2002, and Dec 12, 2005, we enrolled 235 patients with HER2-positive disease, of whom 118 received chemotherapy alone and 117 received chemotherapy plus trastuzumab. 99 additional patients with HER2-negative disease were included in the parallel cohort. After a median follow-up of 5.4 years (IQR 3.1-6.8) the event-free-survival benefit from the addition of trastuzumab to chemotherapy was maintained in patients with HER2-positive disease. 5 year event-free survival was 58% (95% CI 48-66) in patients in the trastuzumab group and 43% (34-52) in those in the chemotherapy group; the unadjusted hazard ratio (HR) for event-free survival between the two randomised HER2-positive treatment groups was 0.64 (95% CI 0.44-0.93; two-sided log-rank p=0.016). Event-free survival was strongly associated with pathological complete remission in patients given trastuzumab. Of the 68 patients with a pathological complete response (45 with trastuzumab and 23 with chemotherapy alone), the HR for event-free survival between those with and without trastuzumab was 0.29 (95% CI 0.11-0.78). During follow-up only four cardiovascular adverse events were regarded by the investigator to be drug-related (grade 2 lymphostasis and grade 2 lymphoedema, each in one patient in the trastuzumab group, and grade 2 thrombosis and grade 2 deep vein thrombosis, each in one patient in the chemotherapy-alone group). INTERPRETATION These results show a sustained benefit in event-free survival from trastuzumab-containing neoadjuvant therapy followed by adjuvant trastuzumab in patients with locally advanced or inflammatory breast cancer, and provide new insight into the association between pathological complete remission and long-term outcomes in HER2-positive disease.
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Affiliation(s)
| | | | | | - Ana Lluch
- Hospital Clínico Universitario de Valencia-INCLIVA Health Research Institute, University of Valencia, Valencia, Spain
| | - Sergei Tjulandin
- NN Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia
| | | | | | | | | | - Mikhail Lichinitser
- NN Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia
| | | | - Eva Ciruelos
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - Belen Ojeda
- Hospital de la Santa Creu i Sant Pau, Department of Medical Oncology, Barcelona, Spain
| | - Mauro Mansutti
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Alla Bozhok
- NN Petrov Research Institute of Oncology, St Petersburg, Russia
| | | | | | | | | | - Jose Baselga
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Gianni L, Eiermann W, Semiglazov V, Manikhas A, Lluch A, Tjulandin S, Zambetti M, Vazquez F, Byakhov MJ, Lichinitser M, Climent MA, Ciruelos E, Ojeda B, Mansutti M, Bozhok A, Magazzu D, Steinseifer J, Valagussa P, Baselga J. Follow-up results of NOAH, a randomized phase III trial evaluating neoadjuvant chemotherapy with trastuzumab (CT+H) followed by adjuvant H versus CT alone, in patients with HER2-positive locally advanced breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.503] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
503 Background: The monoclonal antibody trastuzumab (H) has been shown to improve event-free survival (EFS) and pathologic complete response (pCR) in patients with HER2-positive locally advanced or inflammatory breast cancer receiving neoadjuvant chemotherapy with or without one year of trastuzumab in the primary analysis of the NOAH study (Gianni L, Lancet 2010). Updated EFS and overall survival (OS) results are now presented. Methods: In this international, multicenter, open-label, randomized phase III trial patients with locally advanced or inflammatory breast cancer were randomized 1:1 to receive CT+H followed by adjuvant H versus CT alone. A parallel cohort of 99 comparable patients with HER2-negative disease was included and treated with the same chemotherapy regimen. The neoadjuvant chemotherapy regimen included doxorubicin, paclitaxel, cyclophosphamide, methotrexate and 5-fluorouracil. The primary objective was to compare EFS defined as time from randomization to disease recurrence or progression [local, regional, distant or contralateral] or death due to any cause). Results: After a median follow up of 5.4 years, the EFS benefit with trastuzumab was confirmed. Cardiac tolerability was good despite concurrent administration of trastuzumab with doxorubicin. Two patients (2%) developed reversible symptomatic congestive heart failure and are presently alive. Conclusions: Present analysis confirms the significant EFS benefit observed in the primary analysis of the NOAH study, and shows a strong trend towards improved OS with the addition of trastuzumab to chemotherapy. pCR rate may be considered as a possible primary endpoint and early indicator of benefit in future neoadjuvant studies of HER2-targeted agents. Clinical trial information: 86043495. [Table: see text]
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Affiliation(s)
| | | | | | - Alexey Manikhas
- City Clinical Oncological Dispensary, St. Petersburg, Russia
| | - Ana Lluch
- Hospital Clínico Universitario de Valencia- INCLIVA Health Research Institute, University of Valencia, Valencia, Spain
| | - Sergei Tjulandin
- Russian Oncology Research Center; N.N. Blokhin Cancer Research Center, Moscow, Russia
| | | | | | | | | | | | - Eva Ciruelos
- University Hospital 12 de Octubre, Madrid, Spain
| | - Belen Ojeda
- Hospital de la Santa Creu i Sant Pau, Departement of Medical Oncology, Barcelona, Spain
| | - Mauro Mansutti
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Alla Bozhok
- N.N. Petrov Research Institute of Oncology, St. Petersburg, Russia
| | | | | | | | - Jose Baselga
- Memorial Sloan-Kettering Cancer Center, New York, NY
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Zambetti M, Baselga J, Eiermann W, Guillem V, Semiglazov V, Lluch A, Sabadell D, Bozhok A, Byakhov MJ, Ojeda B, Mansutti M, Mariani G, Moliterni A, Cortes-Funes H, Colozza M, Pienkowski T, Magazzu D, Valagussa P, Bonadonna G, Gianni L. Freedom from progression (FFP) by adding paclitaxel (T) to doxorubicin (A) followed by CMF as adjuvant or primary systemic therapy: 10-yr results of a randomized phase III European Cooperative Trial in Operable Breast Cancer (ECTO). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
537 Background: At the time the ECTO was designed in 1996, taxanes were only indicated for patients with metastatic breast cancer. However, paclitaxel and docetaxel were still to be tested in the adjuvant setting. In addition there was relatively scarce information on the comparative efficacy of neoadjuvant and adjuvant regimens. The ECTO trial was designed to evaluate the addition of paclitaxel to an anthracycline-based adjuvant regimen and to compare this combination with the same regimen given as primary systemic (neoadjuvant) therapy. Methods: A total of 1,355 women with operable breast cancer were randomized to one of three treatments: 1) surgery followed by adjuvant single agent doxorubicin (A) followed by CMF (arm A); 2) surgery followed by adjuvant paclitaxel plus doxorubicin (AT) followed by CMF (arm B); 3) AT followed by CMF followed by surgery (arm C). The two co-primary objectives were to assess the effects on freedom from progression (FFP) of: 1) the addition of paclitaxel to post-operative chemotherapy (arm B versus arm A); and 2) primary versus adjuvant chemotherapy (arm B versus arm C). Results: At 10 years, in the adjuvant setting FFP remained statistically significant in favor of AT followed by CMF (arm B, HR 0.77, P=0.045). Distant FFP was similarly improved but overall survival was not (HR 0.82, P=0.24). There was no significant difference in FFP when chemotherapy was given after surgery compared with the same regimen given before surgery (arm B vs arm C, HR 0.79, P=0.07). In the primary chemotherapy arm, patients who achieved a pathological complete remission (pCR) had improved distant FFP (P < 0.001) compared to patients who did not achieve pCR. When given as primary systemic therapy, the paclitaxel-containing regimen allowed breast-sparing surgery in a significant percentage of patients, which did not translate in an increased risk of ipsilateral breast recurrence compared to the risk observed in patients in the adjuvant arms. Conclusions: Incorporating paclitaxel into anthracycline-based adjuvant therapy resulted in a significantly improved FFP and DFFP.
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Affiliation(s)
| | - José Baselga
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | - Ana Lluch
- Hospital Clínico Universitario de Valencia- INCLIVA Health Research Institute, University of Valencia, Valencia, Spain
| | | | - Alla Bozhok
- N.N. Petrov Research Institute of Oncology, St. Petersburg, Russia
| | | | - Belen Ojeda
- Hospital de la Santa Creu i Sant Pau, Departement of Medical Oncology, Barcelona, Spain
| | - Mauro Mansutti
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Angela Moliterni
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Hernan Cortes-Funes
- Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
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Semiglazov V, Eiermann W, Zambetti M, Manikhas A, Bozhok A, Lluch A, Tjulandin S, Sabadell MD, Caballero A, Valagussa P, Baselga J, Gianni L. Surgery following neoadjuvant therapy in patients with HER2-positive locally advanced or inflammatory breast cancer participating in the NeOAdjuvant Herceptin (NOAH) study. Eur J Surg Oncol 2011; 37:856-63. [PMID: 21843921 DOI: 10.1016/j.ejso.2011.07.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 06/29/2011] [Accepted: 07/25/2011] [Indexed: 11/18/2022] Open
Abstract
AIM To describe surgical outcomes in patients with HER2-positive locally advanced (LABC) or inflammatory breast cancer (IBC) participating in the NeOAdjuvant Herceptin (NOAH) study (ISRCTN86043495). PATIENTS AND METHODS A total of 235 patients with HER2-positive disease were randomized to neoadjuvant trastuzumab plus chemotherapy (doxorubicin plus paclitaxel, followed by paclitaxel, followed by cyclophosphamide, methotrexate and fluorouracil) or neoadjuvant chemotherapy alone. Of these patients, 228 received their allocated treatment (115 received trastuzumab plus chemotherapy and 113 received chemotherapy alone) and were potentially eligible for surgery. Mastectomy was required for all patients with IBC and was recommended for all patients with LABC. However, breast-conserving therapy could be considered for patients with peripheral neoplasms measuring ≤ 4 cm in diameter at diagnosis, with a favorable ratio of tumor to breast volume, or at the patient's request if there had been a good response to treatment. RESULTS As previously reported, the addition of trastuzumab to neoadjuvant chemotherapy improved the overall, complete and pathological complete response to therapy and significantly improved event-free survival (the primary endpoint of the study). Trastuzumab also enabled more patients to have breast conserving surgery (BCS) (23% versus 13% respectively) without an apparent detrimental effect on local disease control (no patient treated with trastuzumab plus chemotherapy had experienced a local recurrence after BCS at the time of analysis). CONCLUSIONS Although this was not an aim of the trial, neoadjuvant trastuzumab given concurrently with chemotherapy enabled 23% of patients with HER2-positive LABC/IBC to avoid mastectomy (including a small number of patients with IBC).
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Affiliation(s)
- V Semiglazov
- NN Petrov Research Institute of Oncology, St. Petersburg Oncology, 68, Leningradskaya Str. Pesochny-2, St. Petersburg, Russian Federation, Russia.
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Gianni L, Eiermann W, Semiglazov V, Manikhas A, Lluch A, Tjulandin S, Zambetti M, Vazquez F, Byakhow M, Lichinitser M, Climent MA, Ciruelos E, Ojeda B, Mansutti M, Bozhok A, Baronio R, Feyereislova A, Barton C, Valagussa P, Baselga J. Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet 2010; 375:377-84. [PMID: 20113825 DOI: 10.1016/s0140-6736(09)61964-4] [Citation(s) in RCA: 867] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The monoclonal antibody trastuzumab has survival benefit when given with chemotherapy to patients with early, operable, and metastatic breast cancer that has HER2 (also known as ERBB2) overexpression or amplification. We aimed to assess event-free survival in patients with HER2-positive locally advanced or inflammatory breast cancer receiving neoadjuvant chemotherapy with or without 1 year of trastuzumab. METHODS We compared 1 year of treatment with trastuzumab (given as neoadjuvant and adjuvant treatment; n=117) with no trastuzumab (118), in women with HER2-positive locally advanced or inflammatory breast cancer treated with a neoadjuvant chemotherapy regimen consisting of doxorubicin, paclitaxel, cyclophosphamide, methotrexate, and fluorouracil. Randomisation was done with a computer program and minimisation technique, taking account of geographical area, disease stage, and hormone receptor status. Investigators were informed of treatment allocation. A parallel cohort of 99 patients with HER2-negative disease was included and treated with the same chemotherapy regimen. Primary endpoint was event-free survival. Analysis was by intention to treat. This study is registered, number ISRCTN86043495. FINDINGS Trastuzumab significantly improved event-free survival in patients with HER2-positive breast cancer (3-year event-free survival, 71% [95% CI 61-78; n=36 events] with trastuzumab, vs 56% [46-65; n=51 events] without; hazard ratio 0.59 [95% CI 0.38-0.90]; p=0.013). Trastuzumab was well tolerated and, despite concurrent administration with doxorubicin, only two patients (2%) developed symptomatic cardiac failure. Both responded to cardiac drugs. INTERPRETATION The addition of neoadjuvant and adjuvant trastuzumab to neoadjuvant chemotherapy should be considered for women with HER2-positive locally advanced or inflammatory breast cancer to improve event-free survival, survival, and clinical and pathological tumour responses. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
- Luca Gianni
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
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Gianni L, Baselga J, Eiermann W, Porta VG, Semiglazov V, Lluch A, Zambetti M, Sabadell D, Raab G, Cussac AL, Bozhok A, Martinez-Agulló A, Greco M, Byakhov M, Lopez JJL, Mansutti M, Valagussa P, Bonadonna G. Phase III Trial Evaluating the Addition of Paclitaxel to Doxorubicin Followed by Cyclophosphamide, Methotrexate, and Fluorouracil, As Adjuvant or Primary Systemic Therapy: European Cooperative Trial in Operable Breast Cancer. J Clin Oncol 2009; 27:2474-81. [DOI: 10.1200/jco.2008.19.2567] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo evaluate the addition of paclitaxel to an anthracycline-based adjuvant regimen and to compare this combination with the same regimen given as primary systemic (neoadjuvant) therapy.Patients and MethodsA total of 1,355 women with operable breast cancer were randomly assigned to one of three treatments: surgery followed by adjuvant doxorubicin (75 mg/m2) followed by cyclophosphamide, methotrexate, and fluorouracil (CMF; arm A); surgery followed by adjuvant paclitaxel (200 mg/m2) plus doxorubicin (60 mg/m2), followed by CMF (arm B); or paclitaxel (200 mg/m2) plus doxorubicin (60 mg/m2) followed by CMF followed by surgery (arm C). The two coprimary objectives were to assess the effects on relapse-free survival (RFS) of the addition of paclitaxel to postoperative chemotherapy (arm B v arm A) and primary chemotherapy versus adjuvant chemotherapy (arm B v arm C).ResultsDoxorubicin plus paclitaxel followed by CMF was well-tolerated as adjuvant or as primary chemotherapy. The addition of paclitaxel to adjuvant doxorubicin followed by CMF significantly improved RFS compared with adjuvant doxorubicin alone followed by CMF (hazard ratio [HR], 0.73; P = .03). Distant RFS was similarly improved (HR, 0.70; P = .027). There was no significant difference in RFS when the paclitaxel/doxorubicin/CMF chemotherapy was given before surgery compared with the same regimen given after surgery (HR, 1.21; P = .18). However, the rate of breast-conserving surgery was significantly higher with preoperative chemotherapy (63% v 34%; P < .001).ConclusionIncorporating paclitaxel into anthracycline-based adjuvant therapy resulted in a significant improvement in RFS and distant RFS. When given as primary systemic therapy, the paclitaxel-containing regimen allowed breast-sparing surgery in a significant percentage of patients.
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Affiliation(s)
- Luca Gianni
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - José Baselga
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Wolfgang Eiermann
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Vincente Guillem Porta
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Vladimir Semiglazov
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Aňa Lluch
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Milvia Zambetti
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Dolores Sabadell
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Günther Raab
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Antonio Llombart Cussac
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Alla Bozhok
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Angel Martinez-Agulló
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Marco Greco
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Mikhail Byakhov
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Juan Josè Lopez Lopez
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Mauro Mansutti
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Pinuccia Valagussa
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
| | - Gianni Bonadonna
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan; Ospedale Universitario Santa Maria della Misericordia, Udine, Italy; Hospital Vall d'Hebron and Hospital de San Pau, Barcelona; Istituto Valenciano de Oncologia and Hospital Clinico Universitario de Valencia, Valencia, Spain; Frauenklinik vom Roten Kreuz, Munich, Germany; N.N. Petrov Research Institute of Oncology, St Petersburg; and the N.A. Semashko Central Clinical Hospital, Moscow, Russia
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Semiglazov V, Bozhok A, Manikhas A, Petrovsky S, Kochetova I, Donskih R, Turkevich E, Semiglazov V, Kanaev S, Tkachenko E. 2042 POSTER Trasuzumab in multimodality treatment of inflammatory breast carcinoma. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70804-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Semiglazov V, Zhiltzova E, Semiglazov V, Kletsel A, Ivanov V, Bozhok A, Zernov K, Kochetova I, Efimenko A, Donskih R. 277 POSTER Breast-conserving surgery (BCS) following neoadjuvant endocrine therapy: exemestane (E) vs tamoxifene (T) in postmenopausal (PM) women with ER-positive breast cancer (T2N1, T3NO-1, T4NOMO). Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gianni L, Baselga J, Eiermann W, Guillem Porta V, Semiglazov V, Lluch A, Zambetti M, Sabadell D, Raab G, Llombart Cussac A, Bozhok A, Martinez-Agulló A, Greco M, Byakhov M, Lopez Lopez JJ, Mansutti M, Valagussa P, Bonadonna G. Feasibility and tolerability of sequential doxorubicin/paclitaxel followed by cyclophosphamide, methotrexate, and fluorouracil and its effects on tumor response as preoperative therapy. Clin Cancer Res 2006; 11:8715-21. [PMID: 16361558 DOI: 10.1158/1078-0432.ccr-05-0539] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The European Cooperative Trial in Operable breast cancer (ECTO) randomly tested whether efficacy of adjuvant doxorubicin followed by i.v. cyclophosphamide, methotrexate, and fluorouracil (CMF; doxorubicin-->CMF, arm A) could be improved by adding paclitaxel (doxorubicin/paclitaxel-->CMF) as adjuvant (arm B) or primary systemic therapy (PST, arm C). We report here feasibility, tolerability, locoregional antitumor activity, and breast conservation rate. METHODS A total of 1,355 women entered the study. Feasibility and safety were compared in arm A versus arms B plus C. Surgical findings were compared in arms A plus B versus arm C. RESULTS Grade 3 or 4 National Cancer Institute toxicities were low (<5%) in all arms. Neuropathy was more frequent in the paclitaxel-containing arms (grade 2, 20.5% versus 5.0%; grade 3, 1.3% versus 0.2%). At 31 months of follow-up, asymptomatic drop of left ventricular ejection fraction was similar in all arms, whereas symptomatic cardiotoxicity was recorded in three patients (0.5%) in A and in three patients (0.3%) in B plus C. PST induced clinical complete plus partial remission in 78%, with an in-breast pathologic complete response rate of 23% and an in-breast plus axilla pathologic complete response rate of 20%. In the multivariate analysis, only estrogen receptor (ER) status was significantly associated with pathologic complete response (odds ratio for ER negative, 5.77; 95% confidence interval, 3.49-9.52; P<0.0001). PTS induced a significant axillary downstaging (P<0.001), and breast sparing surgery was feasible in 65% versus 34% (P<0.001). CONCLUSIONS Doxorubicin/paclitaxel-->CMF is feasible, safe, and well tolerated. Given as PST, it is markedly active, allowing for breast-sparing surgery in a large fraction of patients.
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Affiliation(s)
- Luca Gianni
- Istituto Nazionale Tumori, Milan, Italy, and Hospital Vall d'Hebron, Barcelona, Spain.
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Semiglazov V, Kletsel A, Semiglazov V, Zhiltzova E, Ivanov V, Dashyan G, Bozhok A, Melnikova O, Paltuev R, Berstein L. Exemestane (E) vs tamoxifen (T) as neoadjuvant endocrine therapy for postmenopausal women with ER+ breast cancer (T2N1–2, T3N0–1, T4N0M0). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.530] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- V. Semiglazov
- NN Petrov Research Inst of Oncology, St Petersberg, Russian Federation; Universitats-Frauenklinik, Osnabruck, Germany
| | - A. Kletsel
- NN Petrov Research Inst of Oncology, St Petersberg, Russian Federation; Universitats-Frauenklinik, Osnabruck, Germany
| | - V. Semiglazov
- NN Petrov Research Inst of Oncology, St Petersberg, Russian Federation; Universitats-Frauenklinik, Osnabruck, Germany
| | - E. Zhiltzova
- NN Petrov Research Inst of Oncology, St Petersberg, Russian Federation; Universitats-Frauenklinik, Osnabruck, Germany
| | - V. Ivanov
- NN Petrov Research Inst of Oncology, St Petersberg, Russian Federation; Universitats-Frauenklinik, Osnabruck, Germany
| | - G. Dashyan
- NN Petrov Research Inst of Oncology, St Petersberg, Russian Federation; Universitats-Frauenklinik, Osnabruck, Germany
| | - A. Bozhok
- NN Petrov Research Inst of Oncology, St Petersberg, Russian Federation; Universitats-Frauenklinik, Osnabruck, Germany
| | - O. Melnikova
- NN Petrov Research Inst of Oncology, St Petersberg, Russian Federation; Universitats-Frauenklinik, Osnabruck, Germany
| | - R. Paltuev
- NN Petrov Research Inst of Oncology, St Petersberg, Russian Federation; Universitats-Frauenklinik, Osnabruck, Germany
| | - L. Berstein
- NN Petrov Research Inst of Oncology, St Petersberg, Russian Federation; Universitats-Frauenklinik, Osnabruck, Germany
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Semiglazov V, Ivanov V, Bozhok A, Kletzel A, Ziltzova E, Melnikova O, Paltuev R, Dashyan G, Berstein L, Petrov N. P85 Direct comparison of primary (neoadjuvant) endocrine therapy vs primary chemotherapy in postmenopausal women with ER-positive breast cancer. Breast 2005. [DOI: 10.1016/s0960-9776(05)80121-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Semiglazov VF, Semiglazov V, Ivanov V, Bozhok A, Ziltsova E, Paltuev R, Dashian G, Kletzel A, Topuzov E, Berstein L. The relative efficacy of neoadjuvant endocrine therapy vs chemotherapy in postmenopausal women with ER- positive breast cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.519] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- V. F. Semiglazov
- N.N. Petrov Research Institute of oncology, St Petersberg, Russian Federation
| | - V. Semiglazov
- N.N. Petrov Research Institute of oncology, St Petersberg, Russian Federation
| | - V. Ivanov
- N.N. Petrov Research Institute of oncology, St Petersberg, Russian Federation
| | - A. Bozhok
- N.N. Petrov Research Institute of oncology, St Petersberg, Russian Federation
| | - E. Ziltsova
- N.N. Petrov Research Institute of oncology, St Petersberg, Russian Federation
| | - R. Paltuev
- N.N. Petrov Research Institute of oncology, St Petersberg, Russian Federation
| | - G. Dashian
- N.N. Petrov Research Institute of oncology, St Petersberg, Russian Federation
| | - A. Kletzel
- N.N. Petrov Research Institute of oncology, St Petersberg, Russian Federation
| | - E. Topuzov
- N.N. Petrov Research Institute of oncology, St Petersberg, Russian Federation
| | - L. Berstein
- N.N. Petrov Research Institute of oncology, St Petersberg, Russian Federation
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