Seminars in oncology
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Seminars in oncology · Jun 1999
ReviewPhase III randomized trials of docetaxel in patients with metastatic breast cancer.
In a randomized phase III trial in which docetaxel was compared with doxorubicin in metastatic breast cancer patients who had failed prior alkylating chemotherapy, docetaxel proved more active, achieving responses at a significantly higher rate (complete + partial responses, 48% v 33%). The risk to benefit ratio favors docetaxel. The higher response rate was achieved without the risk of potentially fatal cardiac toxicity evident in patients who received doxorubicin and with a lower risk of infection and febrile neutropenia. ⋯ Those assigned to docetaxel lived significantly longer (median survival, 11.4 v 8.7 months), experienced a longer time before disease progression (19 weeks v 11 weeks), and achieved a higher overall response rate (30% v 11.6%). The toxicity profile of both regimens was manageable. These phase III studies confirmed the activity observed with docetaxel in the phase II trials and support the view point that docetaxel is one of the most active agents available for the treatment of breast cancer.
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Seminars in oncology · Jun 1999
ReviewPhase I-II studies of docetaxel as a single agent in the treatment of metastatic breast cancer.
Docetaxel (Taxotere, Rhône-Poulenc Rorer, Antony, France) is highly effective in the first-line treatment of metastatic breast cancer, achieving an objective response rate of 61% (95% confidence interval, 52% to 69%). This rate of response is seen in patients with poor prognostic factors such as liver metastases and multiple organ involvement. ⋯ Phase II data suggest that docetaxel is the most active agent yet available in the treatment of advanced breast cancer; this conclusion is now supported by the results of randomized phase III trials. These data justify the further investigation of docetaxel alone and in combination chemotherapy.
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Lymphocytes are present in normal breast. A lymphocytic mastopathy characterized by a lymphocytic infiltrate within the breast epithelium has been described, but its relevance as a precursor lesion of mucosa-associated lymphoid tissue (MALT)-type lymphoma of the breast is uncertain. Lymphomas of the breast are uncommon, and a broad variety of histologic types have been reported. ⋯ Burkitt's or Burkitt-like lymphoma can bilaterally involve the breast of a young pregnant or lactating woman and typically behaves aggressively. Primary breast lymphomas behave similarly to lymphomas of similar histologic types and stages presenting at other sites. Treatment of primary breast lymphomas does not include surgery, but is typically based on local radiotherapy, often combined with systemic chemotherapy.
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Seminars in oncology · Jun 1999
ReviewDocetaxel (Taxotere) and neoadjuvant chemotherapy for non-small cell lung cancer.
In locally advanced non-small cell lung cancer with ipsilateral (N2) or contralateral (N3) mediastinal node involvement, the presence of micrometastases results in a poor outcome when patients are treated by surgery alone. The prognosis is also bad in inoperable locally advanced disease (T4) treated solely by radiotherapy. Compared with surgery or radiotherapy alone, the additional use of cisplatin-based induction chemotherapy has been shown to significantly increase the prospects of long-term survival in these patients. ⋯ Several ongoing phase I/II studies are investigating neoadjuvant regimens in which docetaxel is combined with agents such as cisplatin and carboplatin. In preliminary results from a study of docetaxel plus cisplatin, an objective response was seen in 70% of 20 evaluable patients. It is hoped that the use of docetaxel in single-agent or combination induction regimens will prove to prolong patient survival.
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Seminars in oncology · Jun 1999
ReviewWeekly administration of docetaxel (Taxotere): summary of clinical data.
Docetaxel (Taxotere; Rhône-Poulence Rorer, Antony, France) is a highly efficacious antineoplastic agent; however, its administration every 3 weeks produces substantial myelosuppression. Based on recent observations that the administration of paclitaxel on a weekly schedule minimizes myelosuppression, investigation of weekly docetaxel has been initiated. A recently completed phase I study of weekly docetaxel demonstrates markedly decreased myelosuppression with this schedule. ⋯ When used concurrently with radiation therapy, weekly scheduling allowed a maximization of docetaxel dosing, with the maximum tolerated dose being 20 mg/m2/wk. It is likely that this novel schedule of docetaxel will allow the drug to be used with decreased toxicity and will facilitate its incorporation into active combination regimens. Further investigation of this novel schedule of administration is warranted.