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Factors Predicting for Efficacy and Safety of Docetaxel in a Compassionate-Use Cohort of 825 Heavily Pretreated Advanced Breast Cancer Patients

From the Paul Brousse Hospital and Institut Gustave Roussy, Villejuif; Cvitkovic & Associés Consultants, Kremlin-Bicêtre; Centre Oscar Lambret, Lille; Saint Louis Hospital, Paris; Centre Léon Bérard, Lyon; Centre Paoli Calmettes, Marseille; and Roger Bellon and Rhône-Poulenc Rorer, Montrouge, France.

Address reprint requests to Esteban Cvitkovic, MD, Hôpital Paul Brousse,12 Avenue Paul Vaillant Couturier, 94804 Villejuif Cedex, France; email e.cvitkovic{at}cvitkovic-ac.fr

PURPOSE: To identify predictive factors for efficacy and safety in advanced breast cancer (ABC) patients treated in the French compassionate-use docetaxel program.

PATIENTS AND METHODS: A total of 825 ABC patients treated with docetaxel (100 mg/m² every 3 weeks) were source-reviewed and analyzed for prognostic factors associated with overall response rate (ORR), time to treatment failure (TTF), overall survival (OS), febrile neutropenia, mucositis, and severe fluid retention syndrome by univariate and multivariate analysis.

RESULTS: The ORR was 22.9% (95% confidence interval, 20.2% to 26.2%). The median TTF and OS were 4.0 and 9.8 months, respectively. By multivariate analysis, secondary anthracycline-resistant disease was significantly associated (P < .05) with lower ORR and shorter TTF and OS, whereas anthracycline-refractory disease was associated with shorter OS. Poor performance status was associated with lower ORR, shorter TTF, and shorter OS. Liver dysfunction (transaminase levels > 1.5 times the upper limit of normal [ULN] and alkaline phosphatase [AP] level > three times ULN) and time since first relapse less than 24 months were associated with shorter TTF and OS. Other significant correlations included the following: elevated CA 15-3 serum level with lower ORR; more than two involved sites, and minor transaminase and AP level abnormalities with shorter OS; and no previous chemotherapy for ABC with shorter TTF. According to multivariate analysis, ORR, TTF, and OS were not decreased in patients with liver metastases but without liver dysfunction.

CONCLUSION: Docetaxel activity was maintained in heavily pretreated ABC patients and in those with liver metastasis; docetaxel must be used cautiously, however, in patients with liver dysfunction in whom high morbidity risk necessitates strict adherence to dose-adaptation guidelines.

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