Preoperative and perioperative chemotherapy with 5-fluorouracil as continuous infusion in operable breast cancer expressing a high proliferation fraction: Cytotoxic treatment during the surgical phase

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Abstract

Background: Experimental data on perioperative chemotherapy (PeCT) indicate that its initiation might be most useful if administered as close as possible to the time of first 'disturbance of the tumour'. Regimens including 5-fluorouracil (5-FU) as continuous infusion are commonly used in the preoperative setting, especially for large tumours and locally advanced disease. We therefore evaluated the role of PeCT with 5-FU as continuous infusion after preoperative chemotherapy (PreCT), covering the surgical phase and acute wound healing period, in patients with breast cancer too large to attempt breast-conserving surgery upon diagnosis. Patients and methods: Breast cancer patients, clinical stages T2-T3, N0-N2, M0, and Ki-67 labelling index ≥20%, were treated every 3 weeks with a maximum of six courses of vinorelbine 20 mg total dose intravenously (i.v.) on days 1 and 3, cisplatin 60 mg/m2i.v. on day 1 and 5-FU 200 mg/m2/day as a continuous infusion (ViFuP regimen). Patients who achieved a clinical and radiological objective remission with PreCT were also treated with perioperative 5-FU that was continued until 30 min before, and restarted immediately after surgery, prolonging infusion until 15 days after surgery. Results: Following preoperative treatment, 39 of 49 evaluable patients [80%; 95% confidence interval (CI) 70% to 90%] had an objective response. Pathological complete remission (pCR) was achieved in 14 (29%) patients. No relevant clinical or haematological toxicity due to PeCT was observed. In 36 patients submitted to PeCT the rate of pCR was 33% (95% CI 18% to 48%). The highest response of the primary tumour to PreCT and PeCT was observed in women with tumours not expressing estrogen and progesterone receptors (pCR 46%; 95% CI 19% to 73%). Conclusions: Preoperative therapy can be protracted into the surgical (and wound healing) period without significant additional short-term toxicity. Proper selection of patients according to biological features might improve the therapeutic yield of preoperative therapies.

Original languageEnglish
Pages (from-to)1477-1483
Number of pages7
JournalAnnals of Oncology
Volume14
Issue number10
DOIs
Publication statusPublished - Oct 2003

Fingerprint

Fluorouracil
Breast Neoplasms
Drug Therapy
Confidence Intervals
Therapeutics
Wound Healing
Neoplasms
Segmental Mastectomy
Progesterone Receptors
Ambulatory Surgical Procedures
Estrogen Receptors
Patient Selection
Cisplatin

Keywords

  • Fluorouracil
  • Operable breast cancer
  • Perioperative chemotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

@article{eb595e7d215c469bac41b8db729e918e,
title = "Preoperative and perioperative chemotherapy with 5-fluorouracil as continuous infusion in operable breast cancer expressing a high proliferation fraction: Cytotoxic treatment during the surgical phase",
abstract = "Background: Experimental data on perioperative chemotherapy (PeCT) indicate that its initiation might be most useful if administered as close as possible to the time of first 'disturbance of the tumour'. Regimens including 5-fluorouracil (5-FU) as continuous infusion are commonly used in the preoperative setting, especially for large tumours and locally advanced disease. We therefore evaluated the role of PeCT with 5-FU as continuous infusion after preoperative chemotherapy (PreCT), covering the surgical phase and acute wound healing period, in patients with breast cancer too large to attempt breast-conserving surgery upon diagnosis. Patients and methods: Breast cancer patients, clinical stages T2-T3, N0-N2, M0, and Ki-67 labelling index ≥20{\%}, were treated every 3 weeks with a maximum of six courses of vinorelbine 20 mg total dose intravenously (i.v.) on days 1 and 3, cisplatin 60 mg/m2i.v. on day 1 and 5-FU 200 mg/m2/day as a continuous infusion (ViFuP regimen). Patients who achieved a clinical and radiological objective remission with PreCT were also treated with perioperative 5-FU that was continued until 30 min before, and restarted immediately after surgery, prolonging infusion until 15 days after surgery. Results: Following preoperative treatment, 39 of 49 evaluable patients [80{\%}; 95{\%} confidence interval (CI) 70{\%} to 90{\%}] had an objective response. Pathological complete remission (pCR) was achieved in 14 (29{\%}) patients. No relevant clinical or haematological toxicity due to PeCT was observed. In 36 patients submitted to PeCT the rate of pCR was 33{\%} (95{\%} CI 18{\%} to 48{\%}). The highest response of the primary tumour to PreCT and PeCT was observed in women with tumours not expressing estrogen and progesterone receptors (pCR 46{\%}; 95{\%} CI 19{\%} to 73{\%}). Conclusions: Preoperative therapy can be protracted into the surgical (and wound healing) period without significant additional short-term toxicity. Proper selection of patients according to biological features might improve the therapeutic yield of preoperative therapies.",
keywords = "Fluorouracil, Operable breast cancer, Perioperative chemotherapy",
author = "Marco Colleoni and G. Curigliano and I. Minchella and G. Peruzzotti and F. Nol{\`e} and G. Mazzarol and G. Renne and L. Orlando and A. Rocca and P. Veronesi and M. Intra and G. Viale and Sandri, {M. T.} and G. Severi and A. Goldhirsch",
year = "2003",
month = "10",
doi = "10.1093/annonc/mdg411",
language = "English",
volume = "14",
pages = "1477--1483",
journal = "Annals of Oncology",
issn = "0923-7534",
publisher = "NLM (Medline)",
number = "10",

}

TY - JOUR

T1 - Preoperative and perioperative chemotherapy with 5-fluorouracil as continuous infusion in operable breast cancer expressing a high proliferation fraction

T2 - Cytotoxic treatment during the surgical phase

AU - Colleoni, Marco

AU - Curigliano, G.

AU - Minchella, I.

AU - Peruzzotti, G.

AU - Nolè, F.

AU - Mazzarol, G.

AU - Renne, G.

AU - Orlando, L.

AU - Rocca, A.

AU - Veronesi, P.

AU - Intra, M.

AU - Viale, G.

AU - Sandri, M. T.

AU - Severi, G.

AU - Goldhirsch, A.

PY - 2003/10

Y1 - 2003/10

N2 - Background: Experimental data on perioperative chemotherapy (PeCT) indicate that its initiation might be most useful if administered as close as possible to the time of first 'disturbance of the tumour'. Regimens including 5-fluorouracil (5-FU) as continuous infusion are commonly used in the preoperative setting, especially for large tumours and locally advanced disease. We therefore evaluated the role of PeCT with 5-FU as continuous infusion after preoperative chemotherapy (PreCT), covering the surgical phase and acute wound healing period, in patients with breast cancer too large to attempt breast-conserving surgery upon diagnosis. Patients and methods: Breast cancer patients, clinical stages T2-T3, N0-N2, M0, and Ki-67 labelling index ≥20%, were treated every 3 weeks with a maximum of six courses of vinorelbine 20 mg total dose intravenously (i.v.) on days 1 and 3, cisplatin 60 mg/m2i.v. on day 1 and 5-FU 200 mg/m2/day as a continuous infusion (ViFuP regimen). Patients who achieved a clinical and radiological objective remission with PreCT were also treated with perioperative 5-FU that was continued until 30 min before, and restarted immediately after surgery, prolonging infusion until 15 days after surgery. Results: Following preoperative treatment, 39 of 49 evaluable patients [80%; 95% confidence interval (CI) 70% to 90%] had an objective response. Pathological complete remission (pCR) was achieved in 14 (29%) patients. No relevant clinical or haematological toxicity due to PeCT was observed. In 36 patients submitted to PeCT the rate of pCR was 33% (95% CI 18% to 48%). The highest response of the primary tumour to PreCT and PeCT was observed in women with tumours not expressing estrogen and progesterone receptors (pCR 46%; 95% CI 19% to 73%). Conclusions: Preoperative therapy can be protracted into the surgical (and wound healing) period without significant additional short-term toxicity. Proper selection of patients according to biological features might improve the therapeutic yield of preoperative therapies.

AB - Background: Experimental data on perioperative chemotherapy (PeCT) indicate that its initiation might be most useful if administered as close as possible to the time of first 'disturbance of the tumour'. Regimens including 5-fluorouracil (5-FU) as continuous infusion are commonly used in the preoperative setting, especially for large tumours and locally advanced disease. We therefore evaluated the role of PeCT with 5-FU as continuous infusion after preoperative chemotherapy (PreCT), covering the surgical phase and acute wound healing period, in patients with breast cancer too large to attempt breast-conserving surgery upon diagnosis. Patients and methods: Breast cancer patients, clinical stages T2-T3, N0-N2, M0, and Ki-67 labelling index ≥20%, were treated every 3 weeks with a maximum of six courses of vinorelbine 20 mg total dose intravenously (i.v.) on days 1 and 3, cisplatin 60 mg/m2i.v. on day 1 and 5-FU 200 mg/m2/day as a continuous infusion (ViFuP regimen). Patients who achieved a clinical and radiological objective remission with PreCT were also treated with perioperative 5-FU that was continued until 30 min before, and restarted immediately after surgery, prolonging infusion until 15 days after surgery. Results: Following preoperative treatment, 39 of 49 evaluable patients [80%; 95% confidence interval (CI) 70% to 90%] had an objective response. Pathological complete remission (pCR) was achieved in 14 (29%) patients. No relevant clinical or haematological toxicity due to PeCT was observed. In 36 patients submitted to PeCT the rate of pCR was 33% (95% CI 18% to 48%). The highest response of the primary tumour to PreCT and PeCT was observed in women with tumours not expressing estrogen and progesterone receptors (pCR 46%; 95% CI 19% to 73%). Conclusions: Preoperative therapy can be protracted into the surgical (and wound healing) period without significant additional short-term toxicity. Proper selection of patients according to biological features might improve the therapeutic yield of preoperative therapies.

KW - Fluorouracil

KW - Operable breast cancer

KW - Perioperative chemotherapy

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U2 - 10.1093/annonc/mdg411

DO - 10.1093/annonc/mdg411

M3 - Article

C2 - 14504046

AN - SCOPUS:10744231683

VL - 14

SP - 1477

EP - 1483

JO - Annals of Oncology

JF - Annals of Oncology

SN - 0923-7534

IS - 10

ER -