Individually Tailored FEC for Metastatic Cancer

SAN ANTONIO—Treatment 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 (Atlanta).

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.