Análisis de la efectividad de epirrubicina neoadyuvante de alta dosis al usar 4 vs. 6 ciclos en pacientes con cáncer de mama localmente avanzado

Purpose: Cytostatic agents such as antracyclines have showed to be effective in locally advanced breast cancer (LABC). Epirubicin can be used in high dose without increasing severe toxicity. Our aim was to assess high dose epirubicin using 4 vs. 6 cycles. Patients and methods: Patients diagnosed with LABC in our hospital were included. One cohort (n = 48) of patients received 5-fluorouracil 500 mg/ m 2 , epirubicin 100 mg/m 2 and cyclophosphamide 600 mg/m 2 (FE 100 C) every 21 days by 4 cycles (4FE 100 C). Other cohort (n = 48) received 6 cycles (6FE 100 C) of the same scheme. All patients were followed by surgery, radiotherapy and chemotherapy adjuvant. Results: Objective response rate (ORR) was 62.5% for 4FE 100 C cohort and 85.7% for 6FE 100 C cohort (p < 0.004). There was a no significative increase in the rates of pCR (20.8%; p = 0.273) and negative lymph nodes after chemotherapy (37.5%; p = 0.960) when number of cycles received was increased. The principal toxicity by 6FE 100 C was vomiting (52.4%, p = 0.001) and nausea (91.6%; p = .563), both toxicities were grade 1-2. Odds ratio indicated that the use of 6FE 100 C compared with 4FE 100 C increased 1.6 folds the pCR in patients with LABC and intensive dose is the most important controllable factor to determine the pCR without increasing severe toxicity. Conclusion: The benefit of clinical and pathological response was better with a longer treatment of 6 cycles using high dose epirubicin.