Gemcitabine (Gemzar), which is approved in combination with paclitaxel (Taxol) in the first-line, postsurgical treatment of metastatic breast cancer, was the subject of a study presented at the 43rd annual meeting of the American Society of Clinical Oncology (ASCO), with encouraging results in the presurgical treatment of breast cancer.
Results of the study showed that adding gemcitabine to the current standard-of-care treatment was a promising regimen for patients with stage II/III breast cancer. The phase II investigation (abstract #595) evaluated the addition of gemcitabine to the current standard-of-care of epirubicin (Ellence) and cyclophosphamide followed by paclitaxel in patients with stage II/III breast cancer. The treatment schedule was a dose-dense sequential neoadjuvant (presurgical) chemotherapy combination, meaning that the combination was administered at shorter intervals between treatments.
Results showed a promising regimen in terms of pathologic complete response (pCR). In addition, patients who tested positive for the HER2 gene also were given trastuzumab (Herceptin) and demonstrated additional response.
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The trial enrolled stage II/III breast cancer patients (with a median age of 45 years), including inflammatory tumors, a type of breast cancer that causes the breast to swell, redden, and feel warm. Of the 73 patients enrolled in the investigation, 42 (57.5%) were classified as T2, 12 (16.5%) as T3, and 19 (26%) as T4, which included 13 patients with inflammatory tumors. A biopsy was performed before treatment for the biomarker component of the study.
Patients received a first sequence of epirubicin and cyclophosphamide (90/600 mg/m2) for three cycles followed by a second sequence of paclitaxel and gemcitabine (150/2,500 mg/m2) for six cycles. Treatment was administered on day 1, every 2 weeks, with growth factor support. HER2-positive patients (20 patients, 27.3%), were given trastuzumab (2 mg/kg with a loading dose of 4 mg/kg) concomitantly. Afterward, the patients underwent surgery, radiotherapy, and adjuvant hormonal therapy according to individual institutional practice.
All patients from the study showed a response to the regimen. Of the entire study group, 27 patients (36.9%) achieved a pCR, with 50% representation from the HER2-positive patients who also were given trastuzumab. A total of 47 patients (64.4%) underwent conservative surgery.
The grade 3/4 hematologic toxicities were leukopenia in six patients (9%); neutropenia in eight patients (12%), and; anemia in one (2%). Nausea (13%) and vomiting (15%) were the most frequent grade 3/4 nonhematologic toxicities. Asymptomatic decrease in cardiac ejection fraction was observed in one patient treated with trastuzumab, with subsequent normalization.
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