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

  • Gogia, Ajay (Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences) ;
  • Raina, Vinod (Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences) ;
  • Deo, Suryanarayan Vishnu (Surgical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences) ;
  • Shukla, Nootan Kumar (Surgical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences) ;
  • Mohanti, Bidhu Kalyan (Radiation Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences) ;
  • Sharma, Daya Nand (Radiation Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences)
  • Published : 2014.03.01

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 $75mg/m^2$, epirubicin $75mg/m^2$, cyclophosphamide $50mg/m^2$ on Day 1, 3 weekly) and a sequential regimen (4 cycles of FEC, 5-flurouracil $600mg/m^2$, epirubicin $75mg/m^2$, cyclophosphamide $600mg/m^2$ followed by 4 cycles of docetaxel $85mg/m^2$). 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.

References

  1. Untch M, Loibl S, Bischoff J, et al (2012). Lapatinib versus trastuzumab in combination with neoadjuvant anthracyclinetaxane-based chemotherapy (GeparQuinto, GBG 44): a randomised phase 3 trial. Lancet Oncol, 13, 135-9. https://doi.org/10.1016/S1470-2045(11)70397-7
  2. Sikov WM, Dizon DS, Strenger R, et al (2009). Frequent pathologic complete responses in aggressive stages II to III breast cancers with every-4-week carboplatin and weekly paclitaxel with or without trastuzumab: a Brown University Oncology Group Study. J Clin Oncol, 27, 4693-99. https://doi.org/10.1200/JCO.2008.21.4163
  3. Sikov W, Berry DA, Perou CM, et al (2013). Impact of the addition of carboplatin (Cb) and/or bevacizumab (B) to neoadjuvant weekly paclitaxel (P) followed by dose-dense AC on pathologic complete response (pCR) rates in triplenegative breast cancer (TNBC): CALGB 40603 (Alliance). San Antonio Breast Cancer Symposium. Abstract, 5-14.
  4. Untch M, Rezai M, Loibl S, et al (2010). Neoadjuvant treatment with trastuzumab in HER2-positive breast cancer: results from the GeparQuattro study. J Clin Oncol, 28, 2024-31. https://doi.org/10.1200/JCO.2009.23.8451
  5. von Minckwitz G, Eidtmann H, Rezai M, et al (2012). Neoadjuvant chemotherapy and bevacizumab for HER2-negative breast cancer. N Engl J Med, 366, 299-309. https://doi.org/10.1056/NEJMoa1111065
  6. Von Minckwitz G, Kummel S, Vogel P, et al (2008). Intensified neo-adjuvant chemotherapy in early-responding breast cancer: phase III randomized GeparTrio study. J Natl Cancer Inst, 100, 552-62. https://doi.org/10.1093/jnci/djn089
  7. Yao X, Hosenpud J, Chitambar CR (2012). A phase ii study of concurrent docetaxel, epirubicin and cyclophosphamide as a neoadjuvant chemotherapy regimen in patients with locally advanced breast cancer. J Cancer, 3, 145-51. https://doi.org/10.7150/jca.3980
  8. Papademetriou K, Ardavanis A, Kountourakis P (2010). Neoadjuvant chemotherapy for locally advanced breast cancer:Focus on chemotherapy and biological targeted treatments' armamentarium. J Thoracic Disease, 2, 160-8.
  9. Gupta D, Raina V, Rath GK, et al (2011). Clinical and pathological response rates of docetaxel-based neoadjuvant chemotherapyin locally advanced breast cancer and comparison with anthracycline-based chemotherapies: Eight-year experience from single centre. Indian J Cancer, 48, 410-14. https://doi.org/10.4103/0019-509X.92258
  10. Manoharan N, Tyagi BB, Raina V (2010). Cancer incidences in rural Delhi-2004-05. Asian Pac J Cancer Prev, 11, 73-7.
  11. Mathew J, Asgeirsson KS, Agrawal A, et al (2007). Neoadjuvant chemotherapy in locally advanced primary breast cancers: The Nottingham experience. EJSO, 33, 972-76. https://doi.org/10.1016/j.ejso.2007.02.005
  12. Phua CE, Bustam AZ, Yusof MM, et al (2012). Risk of treatment related death and febrile neutropaenia with taxane-based adjuvant chemotherapy for breast cancer in a middle income country outside a clinical trial setting. Asian Pac J Cancer Prev, 13, 4623-6. https://doi.org/10.7314/APJCP.2012.13.9.4623
  13. Pierga JY, Delaloge S, Espie M, et al (2010). A multicenter randomized phase II study of sequential epirubicin/cyclophosphamide followed by docetaxel with or without celecoxib or trastuzumab according to HER2 status, as primary chemotherapy for localized invasive breast cancer patients. Breast Cancer Res Treat, 122, 429-37. https://doi.org/10.1007/s10549-010-0939-3
  14. Raina V, Medhi K, Deo S (2007). Shukla NK, Mohanti BK, Rath GK. Outcome of combined modality treatment of 412 cases of locally advanced breast cancer (LABC): Data from a tertiary cancer center in India. Breast Cancer Res Treat, 106, 1-350
  15. Rastogi P, Anderson SJ, Bear HD, et al (2008). Preoperative chemo-therapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol, 26, 778-85. https://doi.org/10.1200/JCO.2007.15.0235
  16. Deo SV, Bhutani M, Shukla NK, et al (2003). Randomized trial comparing neoadjuvant vs adjuvant chemotherapy in locally advanced breast cancer (T4bN0-2M0). J Surg Oncol, 84, 192-7. https://doi.org/10.1002/jso.10323
  17. Bull JM, Tormey DC, Li SH (1978). A randomised comparative trial of adriamycine versus methotrexate in combinationdrug therapy. Cancer, 41, 1649-57. https://doi.org/10.1002/1097-0142(197805)41:5<1649::AID-CNCR2820410501>3.0.CO;2-J
  18. Cortazar P, Zhang L, Untch M, et al (2012). Meta-analysis results from the Collaborative Trials in Neoadjuvant Breast Cancer (CTNeoBC). Cancer Res, 18, 72-93.
  19. Chopra R(2001).The Indian scene. J Clin Oncol, 19, 106-11.
  20. Early Breast Cancer Trialists Collaborative Group (1998). Polychemotherapy for early breast cancer: an overview of randomised trials. Lancet, 352, 930-42. https://doi.org/10.1016/S0140-6736(98)03301-7
  21. Gianni L, Eiermann W, Semiglazov V, et al (2010). Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet, 375, 377-84. https://doi.org/10.1016/S0140-6736(09)61964-4
  22. Giordano SH (2003). Update on locally advanced breast cancer. The Oncologist, 8, 521-30. https://doi.org/10.1634/theoncologist.8-6-521
  23. Gradishar WJ, Wedam SB, Jahanzeb M, et al (2005). Neoadjuvant docetaxel followed by adjuvant doxorubicin and cyclophosphamide in patients with stage III breast cancer. Ann Oncol, 16, 1297-304. https://doi.org/10.1093/annonc/mdi254
  24. Guarneri V, Frassoldati A, Bottini A, et al (2012). Preoperative chemotherapy plus trastuzumab, lapatinib, or both in human epidermal growth factor receptor 2-positive operable breast cancer: results of the randomized phase II CHER-LOB study. J Clin Oncol, 30, 1989-99. https://doi.org/10.1200/JCO.2011.39.0823
  25. Baltali E, Altundag MK, Onat DA, et al (2002). Neoadjuvant chemotherapy with Taxotere-epirubicin-5-fluorouracil (TEF) in loco regionally advanced breast cancer: A preliminary report. Tumori, 88, 474-7.
  26. Baselga J, Bradbury I, Eidtmann H, et al (2012). Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomised, open-label, multicentre, phase 3 trial. Lancet, 379, 633-8. https://doi.org/10.1016/S0140-6736(11)61847-3

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