Combined sequential approach in locally advanced breast cancer

M. Zambetti, S. Oriana, P. Quattrone, P. Verderio, M. Terenziani, R. Zucali, P. Valagussa, G. Bonadonna

Research output: Contribution to journalArticlepeer-review


Background: The interaction between primary and adjuvant chemotherapy is a crucial point in the treatment of locally advanced breast cancer. Objective: To evaluate the therapeutic efficacy of a sequential treatment with primary anthracyclines and adjuvant CMF in this patient subset. Design: Prospective cohort study. Patients: Eighty-eight breast cancer patients, stage T3b-T4 abc, N0-2, M0. Results: From February 1991 to July 1994, 88 consecutive patients with locally advanced breast cancer were treated at the Istituto Nazionale Tumori, Milano, with full-dose doxorubicin (75 mg/m2) or epirubicin (120 mg/m2) for three cycles followed by surgery, adjuvant chemotherapy with i.v. CMF for six cycles and local radiotherapy ± Tamoxifen. A high rate of objective responses (70%), but a low incidence of pathologic complete remission (2%), were observed following primary treatment with single-agent anthracyclines. Frequency of responses was not associated with tumor estrogen or progesterone receptors status, Mib-1 or grading. In 28 patients (32%) conservative surgery could be performed. At a median follow- up of 52 months, relapse free survival and overall survival are 52% and 62%, respectively. A multivariate analysis demonstrated a significant favorable prognosis in patients with limited nodal involvement at surgery and negative Mib-1 values. This drug sequence failed to significantly ameliorate the long term results in this unfavorable patient subset and more effective drug regimens and innovative therapeutic strategies are needed.

Original languageEnglish
Pages (from-to)305-310
Number of pages6
JournalAnnals of Oncology
Issue number3
Publication statusPublished - 1999


  • Conservative surgery
  • Locally advanced breast cancer
  • Primary chemotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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