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High Dose Sequential Chemotherapy With PBSC<br />

Support in Inflammatory Breast Cancer:<br />

Toxicity <strong>and</strong> Pathologic Response. A French<br />

National Study, Pegase 02 (FNCLCC-SFGM)<br />

P. Viens, M. Janvier, Ai Fabbro, T. Delozier, H. Roche, T. Pa<br />

Medical Oncology Unit, Institute Paoli-Calmettes, Marseille, France<br />

INTRODUCTION<br />

Inflammatory breast cancer (IBC) is an uncommon disease, occurring in about<br />

2 to 4% of all breast cancers. 1<br />

It is generally defined as a clinical entity,<br />

corresponding to the T4d stage of the 1988 International Union against Cancer<br />

(UICC) classification. 2<br />

Despite its low frequency, IBC remains a challenge for oncologists. When<br />

treated with surgery or radiotherapy alone, or both, 5-year survival does not exceed<br />

15%. 3<br />

The use of neoadjuvant chemotherapy has improved treatment of IBC, but<br />

prognosis is still very poor, with 5-year survival rates between 30 <strong>and</strong> 50%, 4-7<br />

<strong>and</strong><br />

there is no current consensus on the "best" induction chemotherapy regimen.<br />

Response to initial chemotherapy has been described as predictive of outcome,<br />

with progression-free <strong>and</strong> overall survival significantly higher for responding<br />

patients than for nonresponding patients. 89<br />

Achievement of complete pathologic<br />

response seems a particularly important prognostic factor. 10-14<br />

We can therefore<br />

speculate that improving efficacy of first-line chemotherapy could be one method<br />

of improving IBC prognosis.<br />

Based on those considerations, the High Dose Chemotherapy for Breast Cancer<br />

Study Group (PEGASE) of the French Federation of Anticancer Centers initiated<br />

such a study (PEGASE 02) aimed at evaluating toxicity <strong>and</strong> feasibility of high-dose<br />

sequential chemotherapy with recombinant granulocyte colony-stimulating factor<br />

(G-CSF; filgrastim) <strong>and</strong> stem cell support in inflammatory breast cancer. In<br />

addition, response to this chemotherapy will be evaluated with an emphasis on<br />

pathologic response <strong>and</strong> impact on disease-free survival <strong>and</strong> survival. This report<br />

examines the toxicity <strong>and</strong> response rate in 100 patients.<br />

279

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