Epirubicin + Cisplatin + Vinorelbine

The combination of epirubicin, cisplatin, and vinorelbine is a chemotherapy regimen primarily used in the treatment of breast cancer. This triple combination has been studied in both primary (neoadjuvant) chemotherapy for locally advanced breast cancer and as first-line treatment for metastatic breast cancer. ### Efficacy in Breast Cancer In primary chemotherapy for T2-3 N0-2 breast carcinomas, the regimen has shown significant efficacy in reducing tumor burden. In a study of 88 women with tumors ≥2.5 cm, the combination achieved: - 72.8% overall clinical response rate (with 11.4% complete clinical response)[1][3] - 20.5% pathological complete response rate[1][3] - 63.6% breast conservative surgery rate, including in patients with large tumors >5 cm[1][3] After 5 years of follow-up, disease-free survival and overall survival were significantly higher in patients who achieved pathological complete response compared to those who did not (63.05 vs. 48.76 months for DFS and 64.59 vs. 55.04 months for OS)[1][3]. For advanced breast cancer, a phase II study demonstrated an impressive 84% objective response rate, including complete response in 13% of patients. All stage III patients achieved downstaging, with pathological complete response in two out of 10 patients. Patients with stage IV disease obtained objective responses in 67% of cases[2]. ### Dosing Regimen The typical dosing schedule used in clinical studies was: - Cisplatin: 50 mg/m² - Epirubicin: 75-100 mg/m² - Vinorelbine: 25 mg/m² These were administered every 3 weeks, with vinorelbine sometimes given on day 8 of the cycle[1][2][3]. ### Safety Profile The combination has demonstrated a manageable toxicity profile: - No cardiac toxicity was observed despite the use of full-dose epirubicin (100 mg/m²) in combination with cisplatin[1][3] - Grade 3/4 adverse events included leukopenia (9.4%), neutropenia (7.9%), and nausea/vomiting (7.3%)[1][3] - Febrile neutropenia occurred in 17% of patients in one study[2] Overall, the regimen was considered well-tolerated and feasible even in small centers, with a favorable cost profile compared to taxane-based regimens[1][3]. This combination represents an effective treatment option for patients with previously untreated advanced breast cancer, offering significant tumor reduction with acceptable toxicity.