First-line high-dose sequential chemotherapy with rG-CSF and repeated blood stem cell transplantation in untreated inflammatory breast cancer: toxicity and response (PEGASE 02 trial)

Despite the generalization of induction chemotherapy and a better outcome for chemosensitive diseases, the prognosis of inflammatory breast cancer (IBC) is still poor. In this work, we evaluate response and toxicity of high-dose sequential chemotherapy with repeated blood stem cell (BSC) transplantation administered as initial treatment in 100 women with non-metastatic IBC. Ninety-five patients (five patients were evaluated as non-eligible) of median age 46 years (range 26–56) received four cycles of chemotherapy associating: cyclophosphamide (C) 6 g m−2 – doxorubicin (D) 75 mg m−2 cycle 1, C: 3 g m−2 – D: 75 mg m−2 cycle 2, C: 3 g m−2 – D: 75 mg m−2 – 5 FU 2500 mg m−2 cycle 3 and 4. BSC were collected after cycle 1 or 2 and reinfused after cycle 3 and 4. rG-CSF was administered after the four cycles. Mastectomy and radiotherapy were planned after chemotherapy completion. Pathological response was considered as the first end point of this trial. A total of 366 cycles of chemotherapy were administered. Eighty-seven patients completed the four cycles and relative dose intensity was respectively 0.97 (range 0.4–1.04) and 0.96 (range 0.25–1.05) for C and D. Main toxicity was haematological with febrile neutropenia ranging from 26% to 51% of cycles; one death occurred during aplasia. Clinical response rate was 90% ± 6%. Eighty-six patients underwent mastectomy in a median of 3.5 months (range 3–9) after the first cycle of chemotherapy; pathological complete response rate in breast was 32% ± 10%. All patients were eligible to receive additional radiotherapy. High-dose chemotherapy with repeated BSC transplantation is feasible with acceptable toxicity in IBC. Pathological response rate is encouraging but has to be confirmed by final outcome. © 1999 Cancer Research Campaig

The role of imaging in staging and monitoring testicular cancer

AbstractThe prognosis for testicular cancer is excellent, with a 5-year survival rate greater than 95%. Patients affected can therefore expect to be cured after treatment. Successful treatment requires assessment of the condition at the various stages of its management. Imaging plays a major role in initial analysis of the lymphatic extension and in looking for metastases. It is essential for evaluating the response to treatment and during follow-up after treatment. CT is the most commonly used imaging method in this context, but the role of PET is currently developing. The purpose of this paper is to review the role of the imaging methods commonly used in the management of testicular cancer

Five years update of sequential high dose doxorubicin, cyclophosphamide and docetaxel in inflammatory breast cancer; PEGAGE05 trial on behalf of FNLCC

10773 Background: Inflammatory breast carcinoma is a distinct clinicopathologic entity with poor survival outcome. Early response to initial chemotherapy was reported as predictive for survival and complete pathological response is considered as a major prognostic factor. This study was conducted to determine the safety and to estimate the efficacy of sequential high dose chemotherapy with doxorubicine (D) + cyclophosphamide (CPM) and docetaxel (Doc), in terms of pathological response, disease-free and overall survival Methods: Fifty-four patients entered into the trial from July 1997 to March 1999; treatment consisted in four 3 weekly cycles of D75 mg/m2 + CPM 6 g/m2 in C1 and C2; Doc 100 mg/m2 q 2w in C3, C4 and C6; D75 mg/m2 + CPM3 g/m2 in C6 and C7. Mastectomy with axillary dissection was performed for responding patients, followed by radiotherapy. Results: An interim analysis showed the same efficacy reported in previous high dose chemotherapy trial Pegase 02, without Docetaxel, and unexpected toxicity with 2 toxic deaths that warranted an early closure of the trial The overall 35% [22.5%–47.9%] grade 1 or 2 pathological response according to Chevallier as compared to the 32% reported in the Pagase 02 trial, suggest no greater efficacy for additionel Docetaxel to high dose D + CPM Five-year disease-free survival and overall survival showed a better tendency in Pegase 05 trial, with respectively 42% and 62% as compared to Pegase 02 trial with 33% and 50% Conclusions: these results suggest some benefit from dose intensified CT in terms of complete pathological response rate with improvment of the disease- free and survival outcome. The positive impact of additional docetaxel will be assessed in the last randomized multicenter Pegase 07 trial. No significant financial relationships to disclose. </jats:p