Alberta Breast Cancer Program

Adjuvant Systemic Therapy Guidelines (Stage III Breast Cancer)

Reviewed and approved 06 April 2006. Drug information sheets for the medications mentioned can be found here.

Stage III breast cancer is subdivided into stage IIIA and stage IIIB.

Stage IIIA is defined as T0 - T3 N2 M0 or T3 N1 M0.

In general, most Stage IIIA cancers are surgically removable with exception of the presence of enlarged axillary lymph nodes which are fixed to underlying structures (N2). In some cases, the breast tumor will be too large to consider a breast conserving surgery (T3, larger than 5 cm tumor) and a mastectomy would be the required surgery unless preoperative (neoadjuvant) chemotherapy is considered.

* FEC¹⁰⁰(Fluoruracil, Epirubicin & Cyclophosphamide) x 4 cycles followed by Taxotere x 4 cycles, clinical trial, or CMF (if contraindication for anthracycline based chemotherapy)
** See algorithm for adjuvant chemotherapy

Stage IIIB is defined as T4 any N M0 or any T N3 M0.

Stage IIIB breast cancer is initially inoperable (unable to remove tumor surgically) because the tumor either invades the chest wall (T4a), skin (T4b), both (T4c), or is an inflammatory breast cancer (T4d). The patient must be seen URGENTLY at the Cross Cancer Institute and potentially receive neoadjuvant chemotherapy prior to any attempt to surgically remove an inflammatory breast cancer. Contact the Appointments Office at (780) 432 8548 for an urgent referral.

* FEC¹⁰⁰(Fluoruracil, Epirubicin & Cyclophosphamide) x 4 cycles followed by Taxotere x 4 cycles, clinical trial, or CMF (if contraindication for anthracycline based chemotherapy)
** Selected cases may be considered for less than mastectomy based on clinical/biopsy findings.

Stage IIIB as well as Stage IIIA breast cancers which are considered inoperable are also referred to as locally advanced breast cancer. The use of neoadjuvant chemotherapy has the potential to downstage the tumor, now making surgical removal possible.

* FEC¹⁰⁰(Fluoruracil, Epirubicin & Cyclophosphamide) x 4 cycles followed by Taxotere x 4 cycles, clinical trial, or CMF (if contraindication for anthracycline based chemotherapy). For patients unable to tolerate chemotherapy, hormonal therapy will be considered.
** Surgery assessed based on tumor response to chemotherapy. Consideration of patient's preference and feasibility of surgery will be taken into account.
*** Radiation therapy for local control of the tumor in cases of failure of tumor to adequately respond to treatment so that surgery is not a viable option directly after chemotherapy. May need surgery at some point depending on discussion between medical / radiation / and surgical specialists.