Study of pathological complete response rate with neoadjuvant concurrent chemoradiation with paclitaxel in locally advanced breast cancer

Iyer, Priya; Radhakrishnan, Venkatraman; Ananthi, Balasubramanian; Sridevi, V.; Dhanushkodi, Manikandan; Sundersingh, Shirley; Ganesarajah, Selvaluxmy

doi:10.4103/ijc.ijc_524_19

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…In our experience, if the doxorubicin cyclophosphamide (AC)/paclitaxel is the preferred chemotherapy approach, then paclitaxel can be safely combined with radiation initially followed by AC subsequently before surgery. 29 A similar study evaluated NAC with AC initially followed by concurrent chemoradiation with twice weekly paclitaxel in LABC. 30 The outcome of other studies in patients with LABC is mentioned in Appendix Table A 6 .…”

Section: Discussionmentioning

confidence: 99%

Locally Advanced Breast Cancer (LABC): Real-World Outcome of Patients From Cancer Institute, Chennai

Dhanushkodi

Sridevi

Shanta

et al. 2021

JCO Global Oncology

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PURPOSE There are sparse data on the outcome of patients with locally advanced breast cancer (LABC). This report is on the prognostic factors and long-term outcome from Cancer Institute, Chennai. METHODS This is an analysis of untreated patients with LABC (stages IIIA-C) who were treated from January 2006 to December 2013. RESULTS Of the 4,577 patients with breast cancer who were treated, 2,137 patients (47%) with LABC were included for analysis. The median follow-up was 75 months (range, 1-170 months), and 2.3% (n = 49) were lost to follow-up at 5 years. The initial treatment was neoadjuvant concurrent chemoradiation (NACR) (77%), neoadjuvant chemotherapy (15%), or others (8%). Patients with triple-negative breast cancer had a pathologic complete response (PCR) of 41%. The 10-year overall survival was for stage IIIA (65.1%), stage IIIB (41.2%), and stage IIIC (26.7%). Recurrence of cancer was observed in 27% of patients (local 13% and distant 87%). Multivariate analysis showed that patients with a tumor size > 10 cm (hazard ratio [HR], 2.19; 95% CI, 1.62 to 2.98; P = .001), hormone receptor negativity (HR, 1.45; 95% CI, 1.22 to 1.72; P = .001), treatment modality (neoadjuvant chemotherapy, HR, 0.56; 95% CI, 0.43 to 0.73; P = .001), lack of PCR (HR, 2.36; 95% CI, 1.85 to 3.02; P = .001), and the presence of lymphovascular invasion (HR, 1.97; 95% CI, 1.60 to 2.44; P = .001) had decreased overall survival. CONCLUSION NACR was feasible in inoperable LABC and gave satisfactory long-term survival. PCR was significantly higher in patients with triple-negative breast cancer. The tumor size > 10 cm was significantly associated with inferior survival. However, this report acknowledges the limitations inherent in experience of management of LABC from a single center.

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Section: Discussionmentioning

confidence: 99%

Locally Advanced Breast Cancer (LABC): Real-World Outcome of Patients From Cancer Institute, Chennai

Dhanushkodi

Sridevi

Shanta

et al. 2021

JCO Global Oncology

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“…In this real-world scenario, patients receiving neoadjuvant chemotherapy with any of the two trastuzumab's showed an overall p-CR rate of 37.6%, with innovator and biosimilar trastuzumab resulting in a p-CR of 28.5% and 41.7%, respectively. Our cohort of patients had higher p-CR rates, irrespective of the number of cycles of neoadjuvant trastuzumab provided, as compared to prior smaller cohorts reported previously from India (34.2% and 36.3%) [22,23]. While, OS and progression-free survival (PFS) could not be calculated for biosimilar versus innovator because of missing data and low sample size.…”

Section: Discussionmentioning

confidence: 53%

Neoadjuvant chemotherapy with biosimilar trastuzumab in human epidermal growth factor receptor 2 overexpressed non-metastatic breast cancer: patterns of use and clinical outcomes in India

Joel¹,

Georgy²,

Thumaty³

et al. 2021

ecancer

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Background Human epidermal growth factor receptor 2 (HER2)-positive breast cancer is associated with poor prognosis and access to anti-HER2 treatment is still a challenge in lower-middle income countries. The availability of the biosimilar trastuzumab has improved access by lowering the costs. We report the pattern of use of neoadjuvant ± adjuvant trastuzumab and outcomes in patients with HER2-positive non-metastatic breast cancer treated with regimens incorporating shorter durations of therapy and the use of the biosimilar trastuzumab compared to the innovator. Methods We conducted a retrospective analysis of patients with non-metastatic HER2-positive breast cancer treated with neoadjuvant ± adjuvant trastuzumab (innovator ( n = 34 (33%)) and biosimilar ( n = 70 (67%)) manufactured by Biocon Biologics) with chemotherapy. Information regarding chemotherapy regimens, duration of trastuzumab use (≤12 weeks and >12 weeks), pathological response (Miller Payne grade), disease free survival (DFS), overall survival (OS) and safety data were collected from electronic medical records. Results A total of 135 patients were analysed with a median age of 51 years (range: 23–82); of these, 57% were postmenopausal, 31.8% were hormone receptor positive and 62.9% had stage III disease. The overall pathological complete response (p-CR) in both breast and axilla increased to 37.6% in patients treated with trastuzumab preoperatively as compared to 22.2% in patients who did not receive any trastuzumab. Patients receiving innovator trastuzumab and biosimilar trastuzumab showed a p-CR of 28.5% and 41.7%, respectively. At a median follow-up of 42 months (range: 3–114), there were 18 relapses and 11 deaths. The 3-year DFS was 87.1% and OS was 92.2%. Cardiac dysfunction developed in 4 of 78 (5.1%) evaluable patients. Conclusion Access to anti-HER2 therapy in the treatment of non-metastatic HER2-positive breast cancer in resource-constrained settings has improved significantly with the availability of the biosimilar trastuzumab. Imbalances in patient profiles at baseline in routine clinical practice led to inconclusive outcomes of ≤12 weeks versus >12 weeks trastuzumab treatment. However, on the basis of historical data, patients could be offered shorter duration of trastuzumab when a standard 1-year treatment of adjuvant trastuzumab is not feasible in resource-constrained settings. The p-CR using the biosimilar trastuzumab in neoadjuvant treatment has been observed to be comparable to the innovator trastuzumab.

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“…Patients with LABC received either neoadjuvant chemotherapy followed by surgery and sequential radiation or neoadjuvant chemoradiation followed by surgery. 12 Chemotherapy regimens used in the adjuvant and neoadjuvant setting included three cycles of 5-fluorouracil, epirubicin, and cyclophosphamide (FEC) followed by three cycles docetaxel or six cycles of paclitaxel and epirubicin or four cycles adriamycin and cyclophosphamide (AC) followed by four cycles of paclitaxel. Radiation therapy was delivered using megavoltage 6 (MV) X-rays to the chest wall, supraclavicular, and internal mammary nodal chains using either three-dimensional conformal therapy (3DCRT) or conventional techniques.…”

Section: Methodsmentioning

confidence: 99%

Real-World Experience of Treating Young Adult Patients with Breast Cancer from a Single Center in Southern India

Iyer

Radhakrishnan

Dhanushkodi

et al. 2022

South Asian J Cancer

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Background Breast cancer in young adults is rare and accounts for 5 to 6% of all cancers in this age group. We conducted the present study to look at the demographic features, clinical presentation, and outcomes in this group of patients treated at our center. Patients and Methods The study included breast cancer patients between the age of 15 and 30 years treated at our institute from January 2009 to December 2016. Data were analyzed retrospectively from case records. Event-free survival (EFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Results Young adult breast cancers were reported in 145 out of 6,000 patients (2.41%) diagnosed with breast cancer in the study period. The median age of the patients was 29 years (range: 21–30 years). Stage I, II, III, and IV was observed in 3.4, 33.7, 46.2, and 16.5% of patients, respectively. The median follow-up was 45 months (range: 1.7–128.1 months). The 5-year EFS and OS for stage I, II, III, and IV was 100, 74.5, 47.9, and 0% and 100, 90.8, 55.1, and 0%, respectively. On univariate analysis, stage of the disease and pregnancy-associated breast cancers were found to have a significant association with decreased EFS and OS (p < 0.001, p = 0.008 and p < 0.001, p = 0.001, respectively). On multivariate analysis, stage of disease and pregnancy-associated breast cancers remained significant predictors of EFS and OS. Conclusion Breast cancers in young adults are rare but need to be diagnosed at an early stage to improve survival. Pregnancy-associated breast cancers need to be managed optimally without delay owing to their aggressive tumor biology.

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Study of pathological complete response rate with neoadjuvant concurrent chemoradiation with paclitaxel in locally advanced breast cancer

Cited by 8 publications

References 17 publications

Locally Advanced Breast Cancer (LABC): Real-World Outcome of Patients From Cancer Institute, Chennai

Locally Advanced Breast Cancer (LABC): Real-World Outcome of Patients From Cancer Institute, Chennai

Neoadjuvant chemotherapy with biosimilar trastuzumab in human epidermal growth factor receptor 2 overexpressed non-metastatic breast cancer: patterns of use and clinical outcomes in India

Real-World Experience of Treating Young Adult Patients with Breast Cancer from a Single Center in Southern India

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