TY - JOUR
T1 - Prolonged neoadjuvant treatment plus GM-CSF in locally advanced breast cancer
T2 - Clinical and biological concepts
AU - Pohlmann, Paula Raffin
AU - Suchil Bernal, Laura
AU - Fuentes Alburo, Adolfo
AU - Buter, Jan
AU - Gallardo Rincón, Dolores
AU - Mohar, Alejandro
AU - Mayordomo, Jose Ignacio
AU - Van Der Hoeven, Jacobus J.M.
AU - Van Der Wall, Elsken
AU - De Gruijl, Tanja D.
AU - Pinedo, Herbert M.
PY - 2004/4
Y1 - 2004/4
N2 - Results of standard multimodality treatment for locally advanced breast cancer (LABC) are still disappointing, due to a persistent high risk of relapse and death with longer-term follow-up. Increasing knowledge of tumour immunology provides the basis for new strategies in clinical trial design. Chemotherapy reduces tumor mass and tumor-derived immunosuppressive factors and, at the same time, causes release of tumor antigens; thereby favouring immune activation. An intermediate high-dose chemotherapy schedule with doxorubicin and cyclophosphamide, in combination with granulocyte-macrophage colony stimulating factor (GM-CSF) has been developed. Long-term neoadjuvant application of this regimen may overcome the dysfunction of the immune system and help to eradicate the tumor. Furthermore, tumor-derived antiangiogenic factors might inhibit outgrowth of micrometastases. This review aims to discuss current experience with LABC treatment, taking into account therapeutic alternatives and biological concepts tested in an international phase III trial; the Spinoza Trial.
AB - Results of standard multimodality treatment for locally advanced breast cancer (LABC) are still disappointing, due to a persistent high risk of relapse and death with longer-term follow-up. Increasing knowledge of tumour immunology provides the basis for new strategies in clinical trial design. Chemotherapy reduces tumor mass and tumor-derived immunosuppressive factors and, at the same time, causes release of tumor antigens; thereby favouring immune activation. An intermediate high-dose chemotherapy schedule with doxorubicin and cyclophosphamide, in combination with granulocyte-macrophage colony stimulating factor (GM-CSF) has been developed. Long-term neoadjuvant application of this regimen may overcome the dysfunction of the immune system and help to eradicate the tumor. Furthermore, tumor-derived antiangiogenic factors might inhibit outgrowth of micrometastases. This review aims to discuss current experience with LABC treatment, taking into account therapeutic alternatives and biological concepts tested in an international phase III trial; the Spinoza Trial.
KW - Angiogenesis
KW - Antineoplastic agents
KW - Cyclophosphamide
KW - Dendritic cells
KW - Doxorubicin
KW - GM-CSF
KW - Locally advanced breast cancer
KW - Neoadjuvant
UR - http://www.scopus.com/inward/record.url?scp=84873674395&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/BF02710114
DO - https://doi.org/10.1007/BF02710114
M3 - Review article
SN - 1699-048X
VL - 6
SP - 130
EP - 139
JO - Clinical and Translational Oncology
JF - Clinical and Translational Oncology
IS - 3
ER -