Journal of Clinical Oncology, Vol 12, 1639-1647, Copyright © 1994 by American Society of Clinical Oncology
Salvage therapies in women who fail to respond to first-line treatment with fluorouracil, epirubicin, and cyclophosphamide for advanced breast cancer
K Porkka, C Blomqvist, P Rissanen, I Elomaa and S Pyrhonen
Department of Radiotherapy and Oncology, University of Helsinki, Finland.
PURPOSE: We studied all salvage therapies given until death or the end of
follow-up evaluation in women who failed to respond to the same first-line
cytotoxic therapy for metastatic breast cancer. PATIENTS AND METHODS: The
study cohort consisted of 140 women who had received the fluorouracil,
epirubicin, and cyclophosphamide (FEC) regimen for metastatic breast
cancer. Eight patients were excluded. No exclusions with respect to disease
site, performance status, or biochemical abnormalities were made. The
median follow-up time was 29 months for surviving patients. RESULTS: Most
patients (88%) died during the follow- up period. Patients received a
median of three salvage therapies (range, zero to eight) during the course
of disease. Most courses (52%) were not assessable for response.
Fifty-percent of courses consisted of chemotherapy: 35% of hormonal and 15%
of combination of cytotoxic and hormonal therapies. The median duration of
therapy (DT) ranged from 4 to 1 months, and decreased with advancing stages
of therapy. Similarly, median time to treatment failure (TTF) ranged from 3
to 0.5 months. For unknown causes, patients who received second-line
hormonal therapy fared better than those who received other forms of
therapy. Of 366 analyzed courses, only one complete response (CR) and 18
partial responses (PRs) were observed (response rate, 11% for assessable
and 5% for all courses). Stable disease for at least 3 months was found in
20% to 25% of courses. Most responses (n = 10) occurred during first
salvage therapy, and no responses were observed after third salvage
therapy. CONCLUSIONS: Response rates for salvage therapies were low, and
median treatment times short. The value of offering more than two salvage
chemotherapy regimens to an unselected group of patients is questionable.
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