How are large stage I, IIA, IIB, or IIIA (T3N1M0 ) breast tumors treated?

Updated: Apr 23, 2020
  • Author: Joseph A Sparano, MD; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

Answer

Patients with large, clinical stage IIA, IIB, or IIIA (T3N1M0) tumors

Preoperative chemotherapy should be considered in these patients if they have any of the following:

  • T3-T4 disease
  • Node-positive disease
  • ER-negative disease
  • HER2-positive disease
  • Tumors that need downsizing for surgery

If the patient has clinically negative axillary nodes, consider SNB. If the patient has clinically positive axillary nodes, consider a core biopsy or fine-needle aspiration (FNA), then SNB if FNA or core biopsy is negative.

Chemotherapy regimens are as follows:

  • TAC: Docetaxel (Taxotere) 75 mg/m2 IV on day 1 plus doxorubicin (Adriamycin) 50 mg/m2 IV on day 1 plus cyclophosphamide 500 mg/m2 IV on day 1 every 3 wk for six cycles or

  • Dose-dense ACP: Doxorubicin 60 mg/m2 IV plus  cyclophosphamide 600 mg/m2 every 2 wk for four cycles; followed by paclitaxel 175 mg/m2 every 2 wk with colony-stimulating factor (CSF) support (more effective than the 3-wk schedule in ER-negative or progesterone receptor (PR)-negative disease) [8] or

  • Dose-dense ACP: Doxorubicin 60 mg/m2 IV plus  cyclophosphamide 600 mg/m2 every 2 wk for four cycles; followed by paclitaxel 175 mg/m2every 2 wk with colony-stimulating factor (CSF) support [9]

  • AC: Doxorubicin 60 mg/m2 IV plus  cyclophosphamide 600 mg/m2 IV on day 1 every 3 wk for four cycles (comparable to CMF [cyclophosphamide, methotrexate, fluorouracil]) [10] or

  • TC: Docetaxel 75 mg/m2 IV on day 1 plus  cyclophosphamide 600 mg/m2 IV on day 1 every 3 wk for four cycles

 For HER2-positive tumors, the following neoadjuvant regimen is administered every 3 wk for three to six cycles [11] :

  • Pertuzumab (Perjeta): 840 mg IV infusion over 60 min, then  420 mg IV infusion over 30-60 min plus
  • Trastuzumab: 8 mg/kg IV infusion over 90 min initially, then 6 mg/kg IV infusion over 30-90 min plus
  • Docetaxel: 75 mg/m² IV infusion initially; may increase to 100 mg/m² IV infusion if initial dose is well tolerated

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