Taxane and Anthracycline Based Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer : Institutional Experience

Abstract

Background: The aim of this study was to assess the response rates (clinical and pathological ) with docetaxel and epirubicin combination chemotherapy and its effect on outcome. Materials and Methods: We retrospectively analysed locally advanced breast cancer (LABC) patients who received NACT from January 2008 to December 2012 in our tertiary care centre. LABC constituted 37% of all breast cancer cases and 120 patients fulfilled the eligibility criteria. The regimens used for NACT were, six cycles of DEC (docetaxel 75 mg/m 2 , epirubicin 75 mg/ m 2 , cyclophosphamide 500 mg/m 2 on Day 1, 3 weekly) and a sequential regimen (4 cycles of FEC, 5-flurouracil 600 mg/m², epirubicin 75 mg/m², cyclophosphamide 600 mg/m² followed by 4 cycles of docetaxel 85 mg/m 2 ). Results: The median age was 47 years (range 23-72). Ninety six ( 80 %) had T4 disease and 90% had clinically palpable lymph nodes at diagnosis. The median size of primary tumor at presentation was 5.9 cm. Hormone receptor positivity was seen in 55% and HER2/neu positivity, in 25%. Triple negative breast cancers constituted 25 % of the cases. The overall clinical response rate ( complete or partial ) was 85% and pathological complete responses were obtained in 15%. Four cases defaulted, 5 patients died of treatment related toxicity and 15% developed febrile neutropenia on DEC. The median duration of follow up was 22 months. The median time to relapse was 20 months and the 3 year relapse free and overall survival rates were 50% and 70% respectively. Conclusions: LABC constituted 37% of all breast cancer cases at our institute. With NACT, pCR was seen in 15% of the cases. Sequential chemotherapy was better tolerated than concurrent anthracyline and taxane chemotherapy with a similar pCR.

Outcome after neoadjuvant chemotherapy in Asian breast cancer patients

“…As most women present with stage II and above breast cancer , neoadjuvant chemotherapy plays an important role in the treatment of breast cancer. Thus far, most pCR rates reported in Asian studies, ranging from 5.9% to 15% , were observed from clinical trials of neoadjuvant chemotherapy or single institutional study with very small sample size, which might be different from actual clinical practice. The pCR rate reported in the present study is comparable to results from other observational studies, as well as the National Surgical Adjuvant Breast and Bowel Project (NSABP) B‐18 trial, in which patients received pre‐operative doxorubicin and cyclophosphamide (AC).…”

Tumor slice culture system to assess drug response of primary breast cancer

“…Therapy resistance was arbitrarily defined in our cohort based on studies performed in BC patients receiving neo-adjuvant chemotherapy, which report that 10-20 % of primary breast tumors are resistant to treatment [ 24 – 26 ]. Interestingly, this arbitrarily defined threshold is consistent with the result obtained from one clinically proven therapy resistant tumor suggesting that our thresholds for therapy resistance may resemble the clinical outcome.…”

A Systemic Analysis on Pemetrexed in Treating Patients with Breast Cancer

“…Breast cancer remains a significant problem for global health as it is one of the most common cause of tumorrelated death world-wide (Fouz et al, 2013;Engin et al, 2013;Sedighi et al, 2013;Zhu et al, 2013;Wu et al , 2014;Cabuk et al, 2014;Chin et al, 2014;Fouladi et al, 2014;Majeed et al, 2014;Gogia et al, 2014;Liu et al, 2014;Louisa et al, 2014;Moazzezy et al, 2014;Niu et al, 2014;Rizalar et al, 2014;Sipetic-Grujicic et al, 2014;Prajoko et al, 2014;Inanc et al, 2014;Varol et al, 2014;Yadav et al, 2014). Pemetrexed is a novel multitargeted antifolate that inhibits several enzymes in the de novo pathways of pyrimidine and purine biosynthesis, including thymidylate synthase, dihydrofolate reductase, and glycinamide ribonucleotide ormyltransferase.…”