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26.  Complementary and Alternative Therapies Used by Turkish Breast Cancer Patients Undergoing Chemotherapy 
Breast Care  2012;7(6):471-475.
Most breast cancer patients use complementary and alternative medicine (CAM), usually in parallel with their conventional treatments. This study was planned to determine the prevalence and determining factors for use of CAM by breast cancer patients undergoing chemotherapy.
Patients and Methods
This descriptive study was carried out between October 2010 and May 2011, and included 96 patients at the Istanbul University Institute of Oncology. The Patient Characteristics form and Complementary and Alternative Medicine Scale were used for data collection. Descriptive and non-parametric tests were performed, and logistic regression analysis was used to predict factors affecting CAM use.
Praying was the most frequently used form of CAM, and most of the herbal supplements used by patients were harmless. Herbal use was higher among patients who had local disease (relative risk (RR) 4.48%, 95% confidence interval (CI) 1.12–17.95), and worship was more common among those who had not undergone surgery (RR 4.66%, 95% CI 1.64–13.20).
The CAM approaches used by patients were found to be safe. However, sage and flax seed usage for estrogen-and progesterone-positive patients and exercise for patients with spinal metastasis can be inappropriate approaches. It is important to question and inform patients about CAM use during treatment.
PMCID: PMC3975629  PMID: 24715829
Breast cancer; Chemotherapy; Complementary and alternative medicine; CAM
27.  Breast Cancer Surgery and Financial Reimbursement in Germany 
Breast Care  2012;7(5):384-388.
The reimbursement for breast cancer-specific operative interventions in Germany is regulated by the diagnosis-related group (DRG) system. The essential elements of the German DRG system, which was developed as a per-case lump-sum payment system, are presented, including the participating institutions. The actual treatment situation in breast cancer surgery is now aptly reflected in the introduction of the OPS (operation and treatment procedure classification) 2012. This is oriented on the classification model of Hoffmann and Wallwiener, with its complexity-based differentiation that reflects the basic idea of different resource usage. Despite the actual potential of the appropriately differentiated encryption of surgical procedures, which illustrates their differences in resource costs and consumption, appropriate reimbursement has still not been achieved. Hopefully, in the future the calculation of the DRGs in the field of breast cancer surgery will be based on data feedback from the hospitals and treatment institutions, and will be more suited to the main purpose of the DRG system, i.e. that reimbursement reflects resource expenditure. A necessary basic tool for differentiated, complexity-oriented encryption has been achieved with the OPS 2012, which mirrors our classification model for oncological, oncoplastic and reconstructive breast surgery.
PMCID: PMC3518935  PMID: 24647777
German diagnosis-related groups (G-DRG); Classification system for oncological, reconstructive and oncoplastic breast surgery; Breast surgery; OPS (operation and treatment procedure classification) 2012; Reimbursement
28.  Peptide Receptor Radionuclide Therapy (PRRT) in a Patient Affected by Metastatic Breast Cancer with Neuroendocrine Differentiation 
Breast Care  2012;7(5):408-410.
Breast cancer (BC) is the most frequent cancer in European women with nearly 30% of the patients eventually developing metastases. Neuroendocrine differentiation is a rare event, but overexpression of somatostatin receptors in BC has been reported in many studies.
Case Report
A patient with liver metastases from BC was treated with peptide receptor radionuclide therapy (PRRT). Computed tomography scan and biochemical examinations showed a clear response to radionuclide therapy.
PRRT may be useful in metastatic BC patients.
PMCID: PMC3518936  PMID: 24647781
Radionuclide therapy; Peptide receptors
29.  Axillary Lymph Node Status in Multicentric Breast Tumors and Breast Tumors with Nipple Involvement 
Breast Care  2012;7(5):394-396.
Axillary lymph node dissection plays an important role in breast cancer management in terms of staging, prediction of prognosis, determination of adjuvant therapy, and local control of the primary tumor. The objective of this study was to evaluate the axillary lymph node involvement in multicentric breast tumors and breast tumors with nipple involvement in comparison with unifocal tumors.
Patients and Methods
We reviewed the records of 267 patients with stage I or IIA disease. The rates of axillary lymph node metastasis (ALNM) in patients with unifocal tumors, multicentric tumors, or nipple involvement were compared.
209 (78%) patients had unifocal tumors, 24 (8%) had multicentric tumors, and 34 (12%) had nipple involvement. The incidence of ALNM was 9.76% in patients with unifocal tumors, 24.84% in patients with multicentric tumors, and 36.71% in patients with nipple involvement. Hence, the incidence of ALNM was significantly higher in patients with nipple involvement or multicentric tumors than in patients with unifocal tumors.
Our data suggest that compared to unifocal tumors, breast tumors with nipple involvement or multiple foci show a significantly higher incidence of ALNM which is a predictor of a poor prognosis.
PMCID: PMC3518937  PMID: 24647779
Breast cancer: multicentric, nipple involvement; Axillary lymph nodes
30.  Extent of Primary Breast Cancer Surgery: Standards and Individualized Concepts 
Breast Care  2012;7(5):364-369.
Surgery is still a main therapeutic option in breast cancer treatment. Nowadays, methods of resection and reconstruction vary according to different tumors and patients. This review presents and discusses standards of care and arising questions on how radical primary breast cancer surgery should be according to different clinical situations. In most early breast cancer patients, breast conservation is the method of choice. The discussion on resection margins is still controversial as different studies show conflicting results. Modified radical mastectomy is the standard in locally advanced breast cancer patients, although there are different promising approaches to spare skin or even the nipple-areola complex. A sentinel node biopsy is the standard of care in clinically node-negative invasive breast cancer patients, whereas the significance of axillary lymphonodectomy seems to be questioned through a number of different findings. Although there are interesting findings to modify surgical approaches in very young or elderly breast cancer patients, it will always be an individualized approach if we do not adhere to current guidelines. Up to date, there are no special surgical procedures in BRCA mutation carriers or patients of high-risk families.
PMCID: PMC3518938  PMID: 24647774
Breast cancer surgery; Resection margins; Sentinel lymph node biopsy; Axillary lymphonodectomy
31.  Determinant of Long-Term Quality of Life: Surgery in Breast Cancer Treatment 
Breast Care  2012;7(5):361-362.
PMCID: PMC3518939  PMID: 24647773
32.  Advanced Breast Angiosarcoma Completely Responding to Gemcitabine-Containing Chemotherapy 
Breast Care  2012;7(5):414-416.
For patients with anthracycline-resistant metastatic angiosarcoma, there is currently no available standard for second-line therapy, and a need exists for novel effective regimens to improve response rates.
Case Report
We report here on a case of a primary angiosarcoma of both breasts in a 34-year-old woman presenting with lung metastases. Upon completion of 3 cycles of the MAID regimen (mesna, adriamycin, ifosfamide, dacarbazine), computed tomography showed disease progression. Subsequently, a second-line chemotherapy was started using the GVP regimen (gemcitabine, vincristine, cisplatin). Complete response of the lung metastases was achieved after 6 cycles of treatment.
In the absence of an effective therapy among patients with anthracycline-resistant metastatic breast angiosarcoma, a GVP chemotherapy regimen can be performed as a selective option.
PMCID: PMC3518940  PMID: 24647783
Breast neoplasm; Angiosarcoma; Lung metastases; Gemcitabine; Vincristine; Cisplatin; Chemotherapy
33.  New Technologies in Breast Cancer Surgery 
Breast Care  2012;7(5):370-376.
Since breast-conserving surgery has become the gold standard for early breast cancer, the development of less radical or less burdensome technologies has been pressed for in order to preserve the patient from unnecessary harm through the operative procedure. Different technical approaches are under evaluation, and some of them are already being used in the clinical setting. The aim of this article is to present a perspective on future breast cancer surgery by shedding light on the current innovative and new techniques.
PMCID: PMC3518941  PMID: 24647775
Breast cancer; Intraoperative surgical margin assessment; Radiofrequency spectroscopy; Sentinel node detection; Acellular dermal matrix
34.  A New and Simple Predictive Formula for Non-Sentinel Lymph Node Metastasis in Breast Cancer Patients with Positive Sentinel Lymph Nodes, and Validation of 3 Different Nomograms in Turkish Breast Cancer Patients 
Breast Care  2012;7(5):397-402.
Nomogram accuracies for predicting non-sentinel lymph node (SLN) involvement vary between different patient populations. Our aim is to put these nomograms to test on our patient population and determine our individual predictive parameters affecting SLN and non-SLN involvement.
Patients and Methods
Data from 932 patients was analyzed. Nomogram values were calculated for each patient utilizing MSKCC, Tenon, and MHDF models. Moreover, using our own patient- and tumor-depended parameters, we established a unique predictivity formula for SLN and non-SLN involvement.
The calculated area under the curve (AUC) values for MSKCC, Tenon, and MHDF models were 0.727 (95% confidence interval (CI) 0.64–0.8), 0.665 (95% CI 0.59–0.73), and 0.696 (95% CI 0.59–0.79), respectively. Cerb-2 positivity (p = 0.004) and size of the metastasis in the lymph node (p = 0.006) were found to correlate with non-SLN involvement in our study group. The AUC value of the predictivity formula established using these parameters was 0.722 (95% CI 0.63–0.81).
The most accurate nomogram for our patient group was the MSKCC nomogram. Our unique predictivity formula proved to be as equally effective and competent as the MSKCC nomogram. However, similar to other nomograms, our predictivity formula requires future validation studies.
PMCID: PMC3518942  PMID: 24647780
Sentinel lymph node biopsy; MSKCC nomogram; Tenon score; Turkish nomogram; Non-sentinel lymph node metastasis
35.  Bone Scan or 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography; Which Modality Better Shows Bone Metastases of Breast Cancer? 
Breast Care  2012;7(5):389-393.
In this multicenter study, we aimed to compare concurrent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and bone scan results of breast cancer patient.
Patients and Methods
162 patients with breast cancer (158 female, 4 male; mean age 50.6 years) were included in the study. FDG PET/CT examination was performed in all patients, and concurrent bone scintigraphy in 68 patients. The results of FDG PET/CT and bone scan were compared.
132 of the 162 patients were operated on because of breast cancer. 89 patients had metastasis, and 4 had recurrent disease according to FDG PET/CT results. Metastatic sites in order of frequency were lymph nodes, bone, lung, liver, adrenal gland, local skin or muscle, brain, and peritoneum (peritonitis carcinomatosa). The sensitivity, specificity, accuracy, and negative and positive predictive value of bone scintigraphy versus FDG PET/CT were 96 vs. 100%, 100 vs. 98%, 100 vs. 83%, 100 vs. 100%, and 90 vs. 100%, respectively.
Although the 2 modalities were in concordance with each other, in 5 (21%) cases, FDG PET/CT could not show bone metastasis which were detected on bone scintigraphy. Hence, bone scintigraphy was superior to FDG PET/CT in the determination of bone metastasis derived from breast cancer. However, FDG PET/CT should be considered for soft tissue metastasis.
PMCID: PMC3518943  PMID: 24647778
Breast cancer; Bone metastasis; FDG PET/CT; Bone scintigraphy
36.  Postmenopausal Breast Tuberculosis – Report of 4 Cases 
Breast Care  2012;7(5):411-413.
Breast tuberculosis is an uncommon disease even in countries where the incidence of tuberculosis is high.
Case Report
This is a case series concerning 4 postmenopausal breast tuberculosis cases encountered in Moulay Youssef Hospital between January 2007 and December 2010. Breast tuberculosis represents 0.25% of all hospitalized tuberculosis patients in our department. The mean age of our patients was 62.5 ± 5.8 years. Clinical findings were heterogeneous; 1 case was multifocal tuberculosis, and another case was coexistent tuberculosis and malignancy of the breast. Mammography and ultrasonography findings were suspicious for malignancy in all 4 cases. Fine needle aspiration was negative in 3 cases. The diagnosis was made in all patients by histological examination of biopsy specimens, which revealed typical tuberculous lesions. Anti-tuberculosis therapy formed the mainstay of treatment.
The clinical and radiological features of mammary tuberculosis can be very confusing and easily mistaken for breast cancer. Symptoms suggestive of tuberculosis warrant a biopsy to exclude possible cancer.
PMCID: PMC3518944  PMID: 24647782
Breast; Lump; Tuberculosis; Menopause
37.  Role of Breast Surgery in BRCA Mutation Carriers 
Breast Care  2012;7(5):378-382.
BRCA mutation carriers have a life-long breast cancer risk between 55 and 85% and a high risk of developing breast cancer at a very young age, depending on the type of mutation. The risk of developing contralateral breast cancer after a first breast cancer is elevated up to 65%, especially in case of BRCA1 mutation and young age at the first breast cancer. Since bilateral prophylactic mastectomy is associated with a risk reduction of 90–95% of developing primary or contralateral breast cancer, this option is a key point within the counseling process for patient information and shared decision-making of mutation carriers. Although the local control after breast-conserving therapy in mutation carriers seems to be comparable to that of sporadic breast cancer patients, individual patient information and counseling should include all alternative procedures of oncologically adequate mastectomy techniques and immediate reconstruction. Excellent cosmetic results, high levels of life quality, and good patient acceptance can be achieved with the recent developments in reconstructive surgery of the breast.
PMCID: PMC3518951  PMID: 24647776
BRCA mutation carrier; Mastectomy techniques; Reconstructive surgery of the breast; Prophylactic mastectomy
38.  Male Breast Cancer: 20-Year Survival Data for Post-Mastectomy Radiotherapy 
Breast Care  2013;8(4):270-275.
The goal of this population-based study was to determine the impact of post-mastectomy radiation therapy on long-term overall survival (OS) of male patients with breast cancer.
Patients and Methods
We investigated 20-year OS rates of 664 patients diagnosed with primary stage I–III breast cancer in former East Germany between 1970 and 1989. Patients had a radical mastectomy with axillary lymph node dissection without systemic adjuvant therapy.
Median follow-up time was 26.2 years (range 19–38 years). 52.4% of the patients had post-mastectomy radiotherapy. Radiotherapy showed different effects in each stage group after 20 years. Whereas there was an OS trend for radiotherapy to harm patients with stage I disease (hazard ratio (HR) 1.45; 95% confidence interval (CI) 0.98–2.15; p = 0.065), radiotherapy showed no benefit in patients with stage II disease (HR 0.82; 95% CI 0.62–1.1; p = 0.15). There was a significant survival benefit for patients with stage III disease receiving radiotherapy (HR 0.60; 95% CI 0.41–0.88; p = 0.008).
Post-mastectomy radiotherapy is associated with longer OS in male patients with stage III breast cancer. Male breast cancer patients at stages I and II do not seem to benefit from radiotherapy, but obsolete irradiation techniques might explain adverse long-term effects in earlier stages.
PMCID: PMC3787884  PMID: 24132074
Male breast cancer; Adjuvant radiotherapy; Adjuvant Therapy; Overall survival
39.  Combined Long-Term Steroid and Immunosuppressive Treatment Regimen in Granulomatous Mastitis 
Breast Care  2012;7(4):297-301.
Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It is related to various etiological factors. The treatment of IGM is challenging as there is a lack of consensus in the literature and treatment options vary widely. Conservative treatment with antibiotics, glucocorticoids and immunosuppressive drugs, and surgery are used in the management of the disease. In this article we report our experience with IGM patients receiving immunosuppressive treatment.
Patients and Methods
The medical records of patients with IGM receiving systemic therapy at the Hacettepe University Hospital between October 2007 and May 2010 were reviewed. 15 cases of histopathologically proven IGM were identified. The data was examined for risk factors and success of treatment.
14 patients were given prednisolone together with azathioprine, and 1 patient who was pregnant at the time of diagnosis received only prednisolone (30 mg/day). 11 (73%) patients had a complete response to systemic therapy. 2 patients had a relapse, of whom 1 required surgical drainage and 1 was treated with a higher dose of glucocorticoids.
Systemic therapy is a safe and effective treatment for IGM. The addition of azathioprine to glucocorticoid therapy permits quick tapering of the steroid doses and increases the treatment success.
PMCID: PMC3515783  PMID: 23904832
Granulomatous mastitis, idiopathic; Corticosteroids; Azathioprine
40.  Tumor-Associated Antigens in Breast Cancer 
Breast Care  2012;7(4):262-266.
The targets for the immune system are antigens present on cancer cells; however, many are not cancer-specific and may also be found on normal tissues. These antigens are often products of mutated cellular genes, aberrantly expressed normal genes, or genes encoding viral proteins. Vaccines constitute an active and specific immunotherapy designed to stimulate the intrinsic antitumor immune response by presenting tumor-associated antigens expressed on normal tissues that are overexpressed on tumor cells.
PMCID: PMC3515784  PMID: 23904827
Breast cancer; Tumor antigen; Vaccine
41.  Potential Use of Vaccines in the Primary Prevention of Breast Cancer in High-Risk Patients 
Breast Care  2012;7(4):281-287.
Cancer vaccines are an emerging therapeutic and prophylactic modality that may play a more important role in cancer prevention and treatment in the future. Therapeutic cancer vaccines are designed to generate a targeted, immune-mediated antitumor response. Successful prophylactic vaccines are those against oncogenic viral infections, such as the human papillomavirus and cervical cancer. However, a tough challenge for the majority of tumor vaccines is the self-nature of tumor antigens. Ongoing studies are investigating methods to enhance vaccine strategies including immune-modulating agents. The present review analyzes the potential use of vaccines in the primary prevention of breast cancer, focusing on the recent extension of vaccine target selection to self-proteins that are overexpressed during the early stages of tumor development but whose expression no longer occurs as we age, a feature that may avoid clinically significant autoimmune sequelae.
PMCID: PMC3515785  PMID: 23904830
Vaccines; Breast cancer prevention
42.  Breast Cancer during Pregnancy: An Interdisciplinary Approach in Our Institution 
Breast Care  2012;7(4):311-314.
Breast cancer is the most common cancer diagnosed during pregnancy.
Case Report
We report on a case of a 26-year-old woman who was diagnosed with right-sided breast cancer in her 15th week of gestation. We discussed possible treatment scenarios and the patient opted for neoadjuvant therapy with taxanes and anthracyclines during pregnancy, followed by delivery and then followed by surgery, antibody therapy, and radiotherapy. The patient received neoadjuvant chemotherapy with paclitaxel 80 mg/m2 weekly for 12 cycles, followed by 4 cycles of epirubicin and cyclophosphamide (90/600 mg/m2) every 3 weeks. Complete clinical response was seen after preoperative chemotherapy. After delivery of a healthy child at 40 weeks of gestation, she received breast-conserving surgery and axillary dissection. Anti-HER2 antibody treatment with trastuzumab was started concomitantly with adjuvant radiotherapy. Endocrine treatment with a gonadotropin-releasing hormone (GnRH) analog and tamoxifen for 5 years was planned to be started after radiotherapy.
Treatment of breast cancer during pregnancy requires an interdisciplinary approach and careful consideration of the patient's stage of disease, the gestational age, and the preferences of the patient and her family.
PMCID: PMC3515786  PMID: 23904834
Pregnancy-associated breast cancer; Outcome of pregnancy; Neoadjuvant chemotherapy; Interdisciplinary care
44.  Population-Based Effects of Mammography Screening in Bavaria on the Distribution of TNM-T Categories with Respect to Different Histological Subgroups 
Breast Care  2012;7(4):303-309.
Organized mammography screening was implemented in Bavaria in 2003, with a target population of about 1.5 million women (aged 50–69 years). We evaluated the population-based effects of mammography screening on the distribution of tumor-node-metastasis (TNM)-T categories with regard to different histological subgroups of breast cancer.
Patients and Methods
Women diagnosed with breast cancer between 2002 and 2008 were included. The annual age-specific incidence rates separated by T category were calculated for different histological subgroups and plotted against time. Time trends were analyzed not only in the screening population but also based on women aged 15–49 and ≥70 years, respectively. Furthermore, correlation coefficients were calculated in order to evaluate the possible association between participation rate and incidence of certain TNM-T categories.
With ductal carcinomas, the incidence of early-stage tumors shows a strong increase in the screening population and a significant correlation with the participation rate, whereas with lobular carcinomas there is a stagnation of incidence in women aged 50–69 years irrespective of TNM-T category.
Short-term effects of mammography screening can already be demonstrated. However, depending on breast cancer type, not all women appear to benefit from screening. The expected long-term reduction of breast cancer mortality remains to be seen.
PMCID: PMC3515788  PMID: 23904833
Mammography; Screening; Breast cancer; Histological types
45.  Intraductal Glycogen-Rich Clear Cell Carcinoma of the Breast: A Rare Presentation and Review of the Literature 
Breast Care  2012;7(4):319-321.
Glycogen-rich clear cell carcinoma of the breast is a rare histological subtype of breast cancer, accounting for 0.9–2.8% of all breast cancer cases. Fewer than 100 cases have been reported in the literature. Most of these tumors are invasive carcinomas. The intraductal glycogen-rich clear cell carcinoma is a very rare occurrence.
Case Report
Herein is described a case of a pure intraductal glycogen-rich clear cell carcinoma of the breast in a 42-year-old premenopausal woman. A literature review has also been carried out. Mammography was inconclusive due to the presence of dense breast tissue, but magnetic resonance imaging (MRI) showed several nodular lesions measuring 7 × 6 cm in diameter and involving the upper aspect of the right breast suggestive of multifocal malignancy. A modified radical mastectomy was performed. The patient started hormonal therapy with tamoxifen and is currently well 16 months after surgery.
A pure intraductal glycogen-rich clear cell carcinoma of the breast is a very rare occurrence. The case presented here exhibited uncommon MRI features, whereas the tumor size is one of the largest reported in the literature. Mammography may be inconclusive in the presence of dense breast tissue, but MRI is of great importance in the preoperative evaluation of the patient.
PMCID: PMC3515789  PMID: 23904836
Clear cell breast carcinoma: glycogen-rich, intraductal
46.  Immunomodulation via Chemotherapy and Targeted Therapy: A New Paradigm in Breast Cancer Therapy? 
Breast Care  2012;7(4):267-272.
Cytotoxic chemotherapy in the treatment of tumors has traditionally been thought to be immunosuppressive. Increasing evidence suggests the contrary and has introduced the concept of ‘immunogenic’ chemotherapy or, in other words, the concept that the innate and adaptive immune systems are critical in determining the long-term efficacy of some cytotoxic-based (and radiotherapy-based) regimens. The underlying mechanisms how these therapies can stimulate an antitumor immune response have been demonstrated recently. In this article, we review the background of this new paradigm and how combinations of traditional agents with the new immunotherapeutic therapies may significantly advance our treatment of breast cancer.
PMCID: PMC3515790  PMID: 23904828
Breast cancer; Tumor-infiltrating lymphocytes; Prognosis; Immunotherapy
47.  Profiling the Immune Stromal Interface in Breast Cancer and Its Potential for Clinical Impact 
Breast Care  2012;7(4):273-280.
Advances in DNA sequencing technologies, as well as refined bioinformatics methods for interpretation of complex datasets, have provided the opportunity to comprehensively assess gene expression in tumours and their surrounding microenvironment. More recently, these advances have highlighted the interplay between the immune effector mechanisms and breast cancer cell biology, emphasizing the long-recognized link between immunity and cancer. Studying immune-associated genes has not only resulted in further stratification within the broad pathological types of breast cancers, but also provided further biological insights into the complex heterogeneity within breast cancer subgroups. On the basis that anti-cancer therapies can modify the host-tumour interaction, investigators have focused their attention on the predictive value of immune parameters as markers of therapeutic anti-tumour response. We discuss the current status of immune signatures in breast cancer and some of the fundamental limitations that need to be overcome to move these discoveries into clinic.
PMCID: PMC3515791  PMID: 23904829
Genomic biomarkers; Immune stromal interface; Breast cancer
49.  Lobular Breast Cancer in a Male Patient with a Previous History of Irradiation Due to Hodgkin's Disease 
Breast Care  2012;7(4):315-318.
Male breast cancer is rare and represents less than 1% of all breast cancers. Considering the fact that the male breast most often does not consist of lobules and acini, lobular carcinoma of the male breast is exceptionally rare.
Case Report
In this paper we present a unique case of alveolar variant of lobular male breast cancer in a 56-year-old patient.
According to our knowledge this is the first presentation of an alveolar variant of lobular male breast cancer that appeared 14 years after chemo- and radiotherapy for the treatment of Hodgkin's disease.
PMCID: PMC3515793  PMID: 23904835
Male breast cancer; Histology; Immunohistochemistry; Pathology
50.  Toxicity Analysis in the ADEBAR Trial: Sequential Anthracycline-Taxane Therapy Compared with FEC120 for the Adjuvant Treatment of High-Risk Breast Cancer 
Breast Care  2012;7(4):289-295.
Data from meta-analyses have shown taxane-containing therapies to be superior to anthracycline-based treatments for high-risk breast cancer.
Patients and Methods
The ADEBAR trial was a multicenter phase III trial in which patients with lymph node-positive breast cancer were prospectively randomized for either sequential anthracycline-taxane or FEC120 therapy. Patients received 4× epirubicin (90 mg/m2) and cyclophosphamide (600 mg/m2) every 3 weeks (q3w), followed by 4× docetaxel (100 mg/m2) q3w (EC-Doc arm), or 6× epirubicin (60 mg/m2) and 5-fluorouracil (500 mg/m2) on days 1 and 8 and cyclophosphamide (75 mg/m2) on days 1–14, q4w (FEC arm). We compared both arms with respect to toxicity and feasibility.
Hematological toxicity was found significantly more often in the FEC arm. Febrile neutropenia was seen in 11.3% of patients in the FEC arm and in 8.4% of patients in the EC-Doc arm (p = 0.027). Non-hematological side effects of grade 3/4 were rarely seen in either arm. Therapy was terminated due to toxicity in 3.7% of the patients in the EC-Doc arm and in 8.0% of the patients in the FEC arm (p = 0.0009).
The sequential anthracycline-taxane regimen is a well-tolerated and feasible alternative to FEC120 therapy.
PMCID: PMC3515794  PMID: 23904831
Breast cancer; Taxane; Anthracycline; Toxicity; ADEBAR trial

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