Neoadjuvant chemotherapy FEC-HD in locally advanced breast cancer

The tolerance and the clinical and histological efficacy of a neoadjuvant chemotherapy FEC-HD including hematopoietic growth factors have been studied in 40 patients with stade II or III breast cancer between February 1991 and February 1997 Tour courses were given, every 21 days, with 5-fluorouracil (750 mg/m(2)/day DI to D4 by continious infusion), epirubicin (35 mg/m(2)/day D2 to D4) and cyclophosphamide (400 mg/m(2)/day, D2 to D4) with G-CSF (5 mu g/kg/day DG to D15). The surgery was performed 3 or 4 weeks after the end of the chemotherapy. All patients had radiotherapy The neoadjuvant chemotherapy induced 37.5% CR, 45% PR, and 154S SD. In 40% of the patients, the surgery was conservative. An histological CR was obtained in 15% with no axillary involvement one time out of two. There was intraductal carcinoma without invasive carcinoma in 7.5%. There was no differences between the response of inflammatory and non inflammatory tumors. One hundred and fifty-eight courses have been delivered. A grade 3 or 4 leuconeutropenia, anemia and thrombopenia have been observed in respectively 34.6%, 6.3% and 8.8% of the courses. A grade 3 or 4 mucositis has been noticed in 2.5% of the the courses. A febrile granulocytopenia has occurred in 3.8% of the courses. The median survival without metastatic progression was 48 months and the median overall survival was not achieved In stade II and III breast cancer, neoadjuvant chemotherapy with FEC-HD obtains an important histological response with an acceptable toxicity. The role of the dose-intensity increase on survival remains to be determined.