Neoadjuvant chemotherapy, known as "first" or "induction chemotherapy" in the therapeutic
assumption of breast cancer is based on the narrow dependence preclinically revealed between
primary tumour, tumoral angiogenesis and growth of distant metastases.
The results of the Aberdeen Group (Smith et al, 2002 ; Hutcheon et al, 2003), of the NSABP
B27 trial (Bear et al, 2003) and of the Gepar-Duo Group (Von Minckwitz et al, 2002) have
shown that a sequential protocol, using docetaxel after an anthracycline-based combination,
allowed a better clinical response leading to more frequent conservative surgeries and, more
importantly, to an increase in the rate of complete pathological response, assessing a better
efficacy.
The use of a reference adjuvant protocol as a neo-adjuvant treatment is fully admissible
because 7 randomized trials have shown a perfect equivalence between an adjuvant protocol and
the same chemotherapy given as an induction treatment Even keeping the principle of a
sequential treatment, a crucial question is to know if this sequential treatment should be
the same for all patients, or if the oncologist could get a better complete pathological
response, disease-free or overall survival rates by an adaptation of treatment to the
objective result beginning after 2 FEC 100 courses by modulation of the following courses.
We will use as a primary regimen 3 FEC cycles + 3 TAXOTERE cycles, a standard adjuvant
regimen (noted in the Temporary Protocol of Treatment of the Inca page 5 (October 2005) as
well as in Saint Paul de Vence 2005 recommendations for adjuvant chemotherapy (Oncologie --
volume 7 - N°5, August 2005, p 370). This standard treatment will be compared to the same
chemotherapy modulated in its repartition according to results obtained by subsequent tumor
evaluations during induction therapy.