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Sequential taxane and anthracycline-containing neo-adjuvant regimens; any rationale behind the sequence?
The Breast 20 (2011) 291
Contents lists available at ScienceDirect
The Breast journal homepage: www.elsevier.com/brst
Letter to the Editor
Sequential taxane and anthracycline-containing neo-adjuvant regimens; any rationale behind the sequence?
To the editor, We read with keen interest the article by Thiery-Vuillemin et al.1 in which the neo-adjuvant study failed to identify any impact of the sequence of taxane administration on the efficacy, and showed that the rate of pathological complete response (pCR) was not statistically different in cohort A (the standard anthracycline-containing regimen followed by docetaxel) and cohort T (the reverse sequence, with docetaxel followed by a anthracycline-containing regimen). We propose that some factors might influence the results of the study. Although the authors mentioned that the two cohorts were well matched in terms of patient characteristics, the proportion of both the basal-like and human epidermal growth factor receptor 2 (HER2)-enriched sub-types tended to be considerably higher (n ¼ 13, 22% and n ¼ 14, 24% vs. n ¼ 11, 17% and n ¼ 7, 11%, respectively) in breast cancer patients of cohort A than of cohort T. The study by Rouzier et al.2 showed that the basal-like and cerbB2/HER2 sub-types of breast cancer are more sensitive to paclitaxel- and doxorubicin-incorporating preoperative chemotherapy than the luminal and normal-like cancers. The basal-like and cerbB2þ subgroups were associated with the highest rates of CR, 45% (95% confidence interval (95% CI), 24–68) and 45% (95% CI, 23–68), respectively, whereas the luminal tumours had a pathologic CR rate of 6% (95% CI, 1–21). Therefore, it might be of interest to determine the effect of the characteristics described above on the rate of the pCR in this study. In addition, it is should be emphasised that a mechanism suggested by Pachmann et al.,3 which might show some evidence that neo-adjuvant regimen designed as taxane followed by anthracycline, may result in a greater decline in the amount of circulating breast cancer cells than the regimen of anthracycline followed by taxane. The study showed that
0960-9776/$ – see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.breast.2011.02.008
neo-adjuvant chemotherapy with paclitaxel in breast cancer patients interestingly causes release of breast cancer cells into circulation, while at the same time reducing tumour size. In this study, during the applied combination therapy, three different phases were observed. A first decline in the number of circulating tumour cells during the epirubicin-containing part of regimen was observed, followed by a steep increase during paclitaxel treatment, and a subsequent re-decrease if a third regimen with the cyclophosphamide–methotrexate-5-fluorouracil combination was administered. This, in turn, might lead to longer-term survival benefit, if taxane is administered first in the neo-adjuvant setting.
References 1. Thiery-Vuillemin A, Llombart-Cussac A, Chaigneau L, Villanueva C, Bazan F, Montcuquet P, et al. Sequential taxane and anthracycline-containing neoadjuvant regimens: the sequential order impact. Breast 2011;20:46–9. 2. Rouzier R, Perou CM, Symmans WF, Ibrahim N, Cristofanilli M, Anderson K, et al. Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res 2005;11:5678–85. 3. Pachmann K, Camara O, Pachmann UA. Influence of primary tumor chemotherapy in breast cancer on circulating tumor cells. Indications for massive cell release into circulation concurrent with tumor size. Breast Cancer Res Treat 2004;88(Suppl. 1):S224 [Abstract 6014].
Ilyas Sahin, Erhan Ararat, Abas Hashimov, Kadri Altundag* Department of Medical Oncology, Hacettepe University, Institute of Oncology, Sihhiye, Ankara 06100, Turkey * Corresponding author. Tel.: þ90 312 3052954; fax: þ90 312 3242009. E-mail address: [email protected] (K. Altundag) 26 October 2010
Contents lists available at ScienceDirect
The Breast journal homepage: www.elsevier.com/brst
Letter to the Editor
Sequential taxane and anthracycline-containing neo-adjuvant regimens; any rationale behind the sequence?
To the editor, We read with keen interest the article by Thiery-Vuillemin et al.1 in which the neo-adjuvant study failed to identify any impact of the sequence of taxane administration on the efficacy, and showed that the rate of pathological complete response (pCR) was not statistically different in cohort A (the standard anthracycline-containing regimen followed by docetaxel) and cohort T (the reverse sequence, with docetaxel followed by a anthracycline-containing regimen). We propose that some factors might influence the results of the study. Although the authors mentioned that the two cohorts were well matched in terms of patient characteristics, the proportion of both the basal-like and human epidermal growth factor receptor 2 (HER2)-enriched sub-types tended to be considerably higher (n ¼ 13, 22% and n ¼ 14, 24% vs. n ¼ 11, 17% and n ¼ 7, 11%, respectively) in breast cancer patients of cohort A than of cohort T. The study by Rouzier et al.2 showed that the basal-like and cerbB2/HER2 sub-types of breast cancer are more sensitive to paclitaxel- and doxorubicin-incorporating preoperative chemotherapy than the luminal and normal-like cancers. The basal-like and cerbB2þ subgroups were associated with the highest rates of CR, 45% (95% confidence interval (95% CI), 24–68) and 45% (95% CI, 23–68), respectively, whereas the luminal tumours had a pathologic CR rate of 6% (95% CI, 1–21). Therefore, it might be of interest to determine the effect of the characteristics described above on the rate of the pCR in this study. In addition, it is should be emphasised that a mechanism suggested by Pachmann et al.,3 which might show some evidence that neo-adjuvant regimen designed as taxane followed by anthracycline, may result in a greater decline in the amount of circulating breast cancer cells than the regimen of anthracycline followed by taxane. The study showed that
0960-9776/$ – see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.breast.2011.02.008
neo-adjuvant chemotherapy with paclitaxel in breast cancer patients interestingly causes release of breast cancer cells into circulation, while at the same time reducing tumour size. In this study, during the applied combination therapy, three different phases were observed. A first decline in the number of circulating tumour cells during the epirubicin-containing part of regimen was observed, followed by a steep increase during paclitaxel treatment, and a subsequent re-decrease if a third regimen with the cyclophosphamide–methotrexate-5-fluorouracil combination was administered. This, in turn, might lead to longer-term survival benefit, if taxane is administered first in the neo-adjuvant setting.
References 1. Thiery-Vuillemin A, Llombart-Cussac A, Chaigneau L, Villanueva C, Bazan F, Montcuquet P, et al. Sequential taxane and anthracycline-containing neoadjuvant regimens: the sequential order impact. Breast 2011;20:46–9. 2. Rouzier R, Perou CM, Symmans WF, Ibrahim N, Cristofanilli M, Anderson K, et al. Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res 2005;11:5678–85. 3. Pachmann K, Camara O, Pachmann UA. Influence of primary tumor chemotherapy in breast cancer on circulating tumor cells. Indications for massive cell release into circulation concurrent with tumor size. Breast Cancer Res Treat 2004;88(Suppl. 1):S224 [Abstract 6014].
Ilyas Sahin, Erhan Ararat, Abas Hashimov, Kadri Altundag* Department of Medical Oncology, Hacettepe University, Institute of Oncology, Sihhiye, Ankara 06100, Turkey * Corresponding author. Tel.: þ90 312 3052954; fax: þ90 312 3242009. E-mail address: [email protected] (K. Altundag) 26 October 2010