Seminars in oncology
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Seminars in oncology · Oct 1998
Clinical TrialTaxane-based three-drug combination in metastatic and adjuvant treatment of breast cancer.
Considering the recommended dose of the docetaxel/doxorubicin combination (75 mg/m2 and 50 mg/m2, respectively), we decided to proceed with a pilot program in untreated metastatic breast cancer aimed at defining a multidrug regimen that could be later randomly compared with a standard doxorubicin-containing polychemotherapy regimen with equidoses of doxorubicin such as the FAC protocol (5-fluorouracil 500 mg/m2, doxorubicin 50 mg/m2, and cyclophosphamide 500 mg/m2) in first-line metastatic and adjuvant treatment of breast cancer patients. We proceeded with a pilot phase II study of the TAC combination, which consists of docetaxel 75 mg/m2 as a 1-hour infusion preceded by doxorubicin 50 mg/m2 and cyclophosphamide 500 mg/m2, both given as an intravenous bolus. Three hundred seventy courses were delivered in 54 anthracycline-naive patients, among whom 62% had visceral metastases. ⋯ The major response rate was 73% overall and 79% in measurable disease. Time to progression and survival are still under evaluation. The TAC combination is an active and well-tolerated regimen that is the basis of two currently open, pivotal, randomized phase III trials comparing TAC with FAC in the metastatic and adjuvant treatment of breast cancer.
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Seminars in oncology · Oct 1998
Clinical TrialTaxanes in combination with doxorubicin in the treatment of metastatic breast cancer.
Given their high level of activity when used as single agents in metastatic breast cancer, the combination of docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) with doxorubicin is a logical development in the search for regimens that will improve prognosis in this disease. In a phase I trial conducted at the Institut Curie and Hospital Paul-Brousse (Paris, France), 42 women with previously untreated metastatic breast cancer received a total of 286 cycles of the combination at six dose levels. Prophylactic steroids and H1 and H2 blockers were given. ⋯ For patients receiving one of the four highest dose levels, the overall response rate was 81% (95% confidence intervals, 63% to 93%); comparable levels of response were seen at all disease sites. The doses recommended for phase II/III studies of this active and well-tolerated combination are either 50 mg/m2 doxorubicin plus 75 mg/m2 docetaxel or 60 mg/m2 of both drugs. Encouraging response rates also have been seen in studies in which paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) was combined with doxorubicin, although cardiotoxicity was a significant factor in some studies.
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Seminars in oncology · Oct 1998
Clinical TrialTaxoids in combination with epirubicin: the search for improved outcomes in breast cancer.
The combination of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) and either doxorubicin or epirubicin has significant activity against metastatic breast cancer. However, the optimal schedule in terms of activity and toxicity is still under investigation. The use of docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) in combination with anthracyclines is also active and could represent a safe and favorable alternative. ⋯ Severe fluid retention and symptomatic cardiotoxicity were not seen. Responses occurred at doses of 75 mg/m2 docetaxel plus 90 mg/m2 epirubicin and above. However, the proportion of responders did not increase with increasing dose, and the 75 mg/m2 docetaxel/90 mg/m2 epirubicin combination has been selected for further phase II study.
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The recommended weekly dose and the maximum tolerated weekly dose of docetaxel (Taxotere; Rhône-Poulenc Rorer, Antony, France) have yet to be determined. We report that a weekly dose of up to 40 mg/m2 docetaxel for 6 weeks is active in pretreated patients with metastatic breast cancer. From a preliminary study, this dose-dense schedule appears to induce less hematologic toxicity than a schedule of 100 mg/m2 every 3 weeks while achieving similar response rates and may represent a valuable alternative involving a shorter treatment time in the palliative therapy of advanced disease in higher-risk patients. The dose-dense weekly administration of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) also appears to be active, although the toxicity profiles of the two taxanes may differ.