SAN ANTONIOTreatment with FEC (fluorouracil, epirubicine,
cyclophosphamide) to a dose optimized for each patient produced an
overall response rate of 82% in a group of 39 Swedish patients with
metastatic breast cancer, Dr. H. Lindman and colleagues, of Uppsala
University and the Karolinska Institute, reported at the 22nd Annual
San Antonio Breast Cancer Symposium.
With standard-dose FEC, toxicity differs among patients, and three
retrospective studies have a found a correlation between low
hematologic toxicity and decreased survival. To optimize the dose for
each patient, the Swedish researchers invented an escalation and
reduction scheme based on hematologic toxicity. To further increase
the dose, G-CSF was added. This tailor-made treatment, called
dose-escalated FEC (dFEC), was used as the control arm in the large
randomized Scandinavian High-Dose Study reported at ASCO 1999
Patients were women under age 60 who had received no prior
chemotherapy for their metastatic disease and no adjuvant anthracyclines.
The tailor-made regimen gives a remarkably high response rate
(82%), a high rate of complete remissions (26%), and an impressive
5-year survival (19%), Dr. Lindman said at the poster session.
Grade 3-4 side effects were infrequent with dFEC, Dr. Lindman said,
and there was no decrease in quality of life in these more
intensively treated patients, compared with a standard-FEC group.