Clinical outcome and predictive factors for docetaxel and epirubicin neoadjuvant chemotherapy of locally advanced breast cancer

Abstract

Background/Aims: We evaluated the efficacy of docetaxel and epirubicin as neoadjuvant chemotherapy in locally advanced breast cancer and assessed the predictive factors for response to neoadjuvant chemotherapy and prognostic factors related to relapse-free survival. Methods: Forty patients who received docetaxel and epirubicinas neoadjuvant chemotherapy for locally advanced breast cancer were evaluated retrospectively. Neoadjuvant chemotherapy consisted of intravenous injection of 75 mg/m 2 docetaxel and 60 mg/m 2 epirubucin on day 1, every 21 days, and two to six cycles. Results: Twenty-five (62.5%) patients showed a partial response, and 15 (37.5%) patients showed a stable disease in the first response evaluation after two or three cycles of neoadjuvant chemotherapy. In the second response evaluation of nine patients who received six cycles of neoadjuvant chemotherapy, one patient achieved a complete response, but two patients with hormone receptor-negative, human epidermal growth factor receptor 2-positive breast cancer experienced disease progression. Twenty-five (62.5%) patients experienced downstaging after neoadjuvant chemotherapy. Patients with > 20% pretreatment Ki-67 and decrease of Ki-67 between pre-and post-neoadjuvant chemotherapy showed a trend for better response. In multivariate analysis, advanced pathological stage showed a significant negative effect on relapse-free survival. Conclusions: Docetaxel and epirubicin neoadjuvant chemotherapy showed a good response in locally advanced breast cancer. Pretreatment Ki-67 and change of Ki-67 may play a role as predictive factor for response to neoadjuvant chemotherapy.

Efficacy and Safety of Concurrent Chemoradiotherapy with Docetaxel for Locally Advanced Breast Carcinoma after Modified Radical Mastectomy

“…Most patients in the two treatment groups showed clinical response to Stable disease (SD) and Complete responses (CR), which is consistent with the results of the study Malgorzata K Tuxen et al (2014) (19). The effectiveness of therapeutic measures performed in the two treatment groups did not show a statistically significant difference that is consistent with the results of other studies (20,21).…”

A Study Protocol for Assessment of Outcomes of Adjuvant versus Neoadjuvant Chemotherapy in Stage-IIIA of Breast Cancer

“…Commonly used regimens for LABC are Adriamycin along with cyclophosphamide based or taxane based which increase the rate of breast conservative surgeries and minimize the need for aggressive nodal surgery with axillary lymph node dissection as well as allows in vivo tumour response assessment and prognosis based on degree of tumour response to NACT. Patients with luminal status Her 2 neu enriched or triple negative disease also benefit from early treatment of distant micro-metastasis due to increased metastatic potential of these disease type [2].…”

Do all patients with breast cancer benefit from neoadjuvant chemotherapy?

“…In two previous studies in the setting of treatment with combinations of anthracyclines and docetaxel, the clinical response and pCR rates were 68%–93% and 8%–16%, respectively [ 9 , 10 ]. Unfortunately, in Won et al [ 8 ], the pCR rate was lower than in previous studies, possibly because of a low number of treatment cycles, reduced efficacy, or inappropriate patient selection. NAC regimens comprising anthracyclines and taxanes can increase the incidence of febrile neutropenia, possibly delaying treatment or reducing its efficacy, although Won et al [ 8 ] did not mention episodes of myelosuppression.…”

“…Unfortunately, in Won et al [ 8 ], the pCR rate was lower than in previous studies, possibly because of a low number of treatment cycles, reduced efficacy, or inappropriate patient selection. NAC regimens comprising anthracyclines and taxanes can increase the incidence of febrile neutropenia, possibly delaying treatment or reducing its efficacy, although Won et al [ 8 ] did not mention episodes of myelosuppression. The authors also did not identify patient subgroups whose pCR rate would be increased by NAC.…”

“…In this issue of the Korean Journal of Internal Medicine, Won et al [ 8 ] reports the clinical outcomes and factors predictive of efficacy for simultaneous docetaxel and epirubicin (DE) NAC in patients with locally advanced breast cancer. In their study, the down-staging rate for locally advanced breast cancer was 62.5%, suggesting that change in the Ki67 level is a predictive factor.…”