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3 results on '"Van Praagh I"'

2. [First-line chemotherapy in operable breast neoplasms: results of 3 protocols]

Author

Cure H, Charrier S, Jp, Ferrière, Van Praagh I, Assier I, Feillel V, De Latour M, Jo, Bay, Jl, Achard, Dauplat J, and philippe chollet

Subjects
Dose-Response Relationship, Drug, Breast Neoplasms, Vinorelbine, Vinblastine, Drug Administration Schedule, Methotrexate, Treatment Outcome, Chemotherapy, Adjuvant, Doxorubicin, Vincristine, Antineoplastic Combined Chemotherapy Protocols, Humans, Female, Fluorouracil, Cyclophosphamide, Epirubicin, Neoplasm Staging, Retrospective Studies
Abstract

In order to avoid modified radical mastectomy, a neoadjuvant approach was adopted in our institute for operable bulky breast cancers. From January, 1982, to December, 1995, 288 patients received primary chemotherapy with 3 different regimens (all doses mg/m2): (1) AVCF/AVCFM, 167 patients (adriamycin 30, vincristine 1 d1, cyclophosphamide 300, fluorouracil 400 d2-d5 and methotrexate 20 d2 and d4, every 28 days); (2) NEM, 78 patients (vinorelbine 25, epirubicin 35, methotrexate 20 d1 and d8, every 28 days); and (3) TNCF, 43 patients (THP-adria 20, d1-d3, vinorelbine 25 d1 and d4, cyclophosphamide 300, fluorouracil 400 d1-d4, every 21 days). Evaluation of the response comprised 3 methods: clinical (C), echographic (E), mammographic (M). The overall objective response rate (C: 63/90/93; E: 49/61/85; M: 53/65/83%) is higher with regimens (2) and (3). The complete response rate was increased 2-fold with TNCF but the hematologic toxicity was very superior with this combination. Patients were all operated for (2) and (3), only several for (1), and the breast conservation rate (68/83/79%) was quite similar in the 3 regimens. The pathological complete response rate reached 23% with TNCF. However the impact on patient survival has to be confirmed.

Published
1997

3. [Indications, contra-indications, expected results and choice of neoadjuvant chemotherapy for operable breast cancer].

Author

Mouret-Reynier MA, Abrial C, Leheurteur M, Durando X, Van Praagh I, Gimbergues P, Achard JL, Ferrière JP, Cure H, and Chollet P

Subjects
Age Factors, Antibodies, Monoclonal administration & dosage, Antibodies, Monoclonal, Humanized, Breast Neoplasms pathology, Breast Neoplasms surgery, Chemotherapy, Adjuvant methods, Contraindications, Docetaxel, Female, Humans, Paclitaxel administration & dosage, Taxoids administration & dosage, Trastuzumab, Treatment Outcome, Vinblastine administration & dosage, Vinblastine analogs & derivatives, Vinorelbine, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Breast Neoplasms drug therapy, Neoadjuvant Therapy methods
Abstract

Neoadjuvant chemotherapy in breast cancer corresponds to the use of a systemic treatment applied before loco-regional treatment (surgery and/or radiotherapy). Initiated in the seventies for treatment of the locally advanced and/or inflammatory breast cancers, induction chemotherapy has been extended in the beginning of eighties for cancers known as operable (size higher than 3 cm and/or in central position) in order to allow a more frequent conservating surgery. This objective is obtained in 75% of the cases approximately without increase in the risk of local relapse and without noxious effect on overall survival, in spite of the delay of the loco-regional treatment. Neo-adjuvant chemotherapy progressively moved with the advent of major drugs in breast cancer which are anthracyclins, vinorelbine and taxans. But to date, no protocol was essential like an uncontested standard. However, it seems that obtaining a complete clinical response is the best guarantor to avoid relapse. That seems to be observed only after 6 cycles, even 8 cycles of chemotherapy, each cycle combining the 2 major drugs for the treatment of breast cancer of which are anthracyclins and taxanes employed according a sequential scheme after a based-anthracyclins treatment, except any cardiac contra-indication. Moreover, the use of targeted therapeuticals like Herceptin, with a chemotherapy, seems to be promising and should be more studied. Finally, when a neoadjuvant chemotherapy is administered, the evaluation of the pre-treatment biopsy helps to establish key patient-management parameters such as tumour type, SBR grade and immunohistochemical parameters. This evaluation provides predictive parameters with regards to drug response (hormonal status, overexpression of Her2). The further studies realised in this way will permit to improve the results yet obtained.

Published
2006

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