Docetaxel (Taxotere) is a semisynthetic taxane that has efficacy in
combination regimens with doxorubicin (Adriamycin) in the treatment
of metastatic breast cancer. This study was instituted to assess the
role of this combination in the neoadjuvant treatment of locally
advanced breast cancer (LABC).
Doxorubicin was administered at 50 mg/m² and docetaxel at 75
mg/m². Doxorubicin/docetaxel (AT) was given every 21 days for a
total of six cycles to patients with stages IIB (T3, N0), IIIA, and
IIIB LABC. Patients were then assessed for clinical response using
standard response criteria. They then underwent a modified radical
mastectomy (MRM). Specimens from MRMs were examined for pathologic
response, which was defined using standard response criteria, with an
additional category of minimal residual disease (pMRD) defined as
microscopic foci of invasive carcinoma in £
2 high-powered field.
Sixteen patients have been entered into the study since January 1998,
and are evaluable at this time for clinical and pathologic response.
Fourteen completed six cycles of AT and proceeded to surgery. One
patient has progressed on therapy after three cycles. One patient,
included in the clinical response data only, had a clinical and
mammographic complete response (CR), refused MRM, and received
radiation alone. The patients median age was 50 years (range:
3169 years). Ten patients (63%) were African-American, 4 (25%)
were Latina, and 2 (12%) were Caucasian.
At diagnosis, 2 patients (13%) were stage IIIB (T3, N0), 10 (62%)
were stage IIIA, and 4 (25%) were stage IIIB. Clinically, 7 patients
(44%) had a CR, 6 (38%) had a partial response (PR), 1 (6%) had a
minimal response, 1 (6%) had stable disease (SD), and 1 (6%)
progressed (PD) on therapy. On pathologic examination, 2 patients
(13%) had CR (pCR), 4 (27%) had pMRD, 7 (46%) had pPR, 1 (7%) had
pSD, and 1 (7%) had pPD.
CONCLUSION: Doxorubicin/docetaxel is active in the neoadjuvant
setting for LABC, with an overall response (CR + PR) of 82%. Forty
percent of patients receiving AT had a pCR or pMRD at MRMa good
prognostic factor in this group of patients.