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Efficacy of a Primary Chemotherapy Regimen Combining Vinorelbine, Epirubicin, and Methotrexate (VEM) as Neoadjuvant Treatment in 89 Patients with Operable Breast Cancer

^a Centre Jean Perrin and INSERM U 71, Clermont-Ferrand, France; ^b Centre Hospitalier Général, Brive La Gaillarde, France

Correspondence: Philippe Chollet, M.D., Centre Jean Perrin and INSERM U 71, 58 Rue Montalembert, B.P. 392, 63011 Clermont-Ferrand Cedex 1, France. Telephone: 04-73-278198; Fax: 04-73-278029; e-mail: Philippe.Chollet{at}cjp.u-clermont1.fr

Purpose. In order to improve the breast conservation rate for noninflammatory operable breast cancer stage II and IIIa, neoadjuvant chemotherapy containing vinorelbine, 25 mg/m², epirubicin, 35 mg/m², and methotrexate, 20 mg/m², VEM, was administered days 1 and 8 every 28 days for six cycles.

Methods. From October, 1991 to April, 1996, 89 patients (median age 52 years, range 31-72; 68 stage II and 19 stage IIIa) received 519 cycles (median six) of VEM chemotherapy.

Results. Hematotoxicity was mild (World Health Organization grade 3-4 neutropenia in 28% of cycles for 22 patients, and anemia or thrombocytopenia >grade 2) when it occurred, and there were no toxic deaths. The clinical objective response was 90% (28% complete response and 62% partial response). All patients underwent surgery: 77 (87%) had conservative and 12 (13%) had modified radical mastectomy, and 12 (14%) reached pathological complete response. At December, 2000, with a median follow-up of 86 months (39-100), 13 patients had relapsed, and five had died of metastatic disease. Median disease-free survival was 100 months (8.4 years) and median survival had not yet been reached.

Key Words. Breast cancer • Neoadjuvant therapy • Vinorelbine • Epirubicin • Methotrexate

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