BACKGROUND: Poor prognosis is associated with estrogen- and/or progesterone 
receptor-positive (ER(+), PGR(+)) premenopausal breast cancer (PM-BC) with high 
Ki-67 labeling index and extensive axillary lymph node involvement. The role of 
adjuvant chemotherapy (CT) and hormonal therapy have not yet been established in 
these patients.
PATIENTS AND METHODS: Twenty-five PM-BC patients received, in sequence, 
leuprorelin, taxane-anthracycline induction chemotherapy, radiation therapy, a 
platinum-based intensification high-dose CT, followed by leuprorelin and 
anastrazole for five years. Vascular endothelial growth factor (VEGF) levels 
were measured as the primary end-point; secondary end-points were 10-year 
relapse-free survival (RFS) and overall survival (OS) rates.
RESULTS: The median patient age was 44 years, and the mean number of positive 
axillary nodes was 14. All patients were ER(+) and/or PGR(+), with a median 
Ki-67 index of 33%. Five patients were Cerb-B2 positive. Grade 4 hematologic 
toxicity was observed in all patients, no patient showed a decrease of cardiac 
ejection fraction and hot flashes and arthralgias were of moderate intensity. 
After a median follow-up of 70 months, VEGF levels significantly decreased 
(p<0.001); 10-year RFS and OS were 76% and 78%, respectively.
CONCLUSION: Total estrogen blockade and high-dose CT in PM-BC patients is 
feasible, has moderate toxicity, significantly reduces VEGF levels, and seems to 
improve the expected RFS and OS.