Factors associated with bone metastasis in breast cancer: a preliminary study in an indonesian population.

Aim: to know the characteristics of breast cancer patients with bone metastasis and its risk factors. Methods: this was a cross-sectional study on breast cancer patients in Dharmais Cancer Hospital between 1998 and 2002. Data were retrieved from medical records and consisted of age, history of hormonal contraceptive use, histopathological type, estrogen receptor (ER) and progesteron receptor (PR) expression, c-erbB-2 and cathepsin D expressions. Results: a total of 197 cases were recruited between the study period. Almost all patients were women with a mean age of 47 years old. The majority of patients were between 36 and 55 years old (69.1%) with a peak between 46 and 50 years. About 70% of the patients had already had advanced diseases (III and IV). Invasive ductal carcinoma was the commonest histopathological type (80%). The expression of ER, PR, c-erbB-2, and cathepsin D were evaluated in 55 patients. Metastases were found to occur in bone (24.4%), lungs (20.8%), and liver (10.7%). Among patients with bone metastasis, 36 patients ((75%) were more than 40 years old and 32 (66.7%) had invasive ductal carcinomas. There was a significant correlation (p=0.011) between bone metastasis and histopathological type. No significant correlation was found between the use of hormonal contraceptives, ER/PR expression, c-erbB-2 and cathepsin D and bone metastasis. Conclusion: most breast cancer patients came in an already advanced stage, either locally or distant metastasis. The most common site of metastasis was the bone, followed by lungs and liver. Histopathological type of invasive ductal carcinoma was associated to the higher incidence of bone metastasis. Further studies are needed to identify patients with high risk of bone metastasis. There is also a need to evaluate predictive factors for the occurrence of bone metastasis at earlier stage.

First-line chemotherapy of advanced or metastatic breast cancer (MBC) with docetaxel and doxorubicin in Indonesia: results from A phase II trial.

Doxorubicin and docetaxel as a single agent are known as active cytotoxic agents for the treatment of metastatic breast cancer (MBC). Their combination has also shown to be highly active as a second-line chemotherapy of MBC. This study was design to evaluate the efficacy and safety of docetaxel-doxorubicin combination as first line chemotherapy of MBC patients in Indonesia. Twenty-six female patients between 31-65 years old with advanced or MBC was enrolled. No prior taxane or cumulative doxorubicin of 250 mg/m2 was allowed and patients should not have a heart disease. Treatment consisted of doxorubicin 50 mg/m2 as intravenous (IV) bolus followed one hour later by docetaxel 60 mg/m2 by IV infusion over 1 hour every 3 weeks for 6 cycles. Premedication with oral corticosteroid was administered a day prior to chemotherapy until the second day of each cycle. Left ventricular ejection fraction was recorded at baseline and after the 6th cycle. At the end of study, a total of 156 cycles of chemotherapy have been delivered. Five and 11 patients had a complete response (CR) and partial response (PR), respectively, which accounted for a 61.54% best overall response. Three patients with extensive liver metastases showed complete disappearance after 6 cycles. Most frequent grade 3-4 toxicities were leukopenia (80.77%) and febrile neutropenia (5.77%). Leukopenia was usually short in duration, occurred mainly during the first and second cycle and did not require dose reduction. No patient developed heart failure. There was one death due to progressive disease after 6 cycles. Combination of doxorubicin 50 mg/m2 and docetaxel 60 mg/m2 was sufficiently active as first-line chemotherapy of MBC, especially in patients with liver metastases, with a manageable toxicity profile.