Evaluation of efficacy and safety of neoadjuvant chemotherapy with weekly paclitaxel in patients with locally advanced and large operable breast cancer

Abstract

11593 Background: Taxanes have been shown to induce high pathologic response rates in patients with early breast cancer. We studied the use of single agent weekly paclitaxel as anterior chemotherapy in large operable (tumour size >5 cm) breast cancer (LOBC) and locally advanced breast cancer (LABC). Methods: In this prospective study, we enrolled women above 18 years with T3–4 any N and N2- 3 any T with nonmetastatic disease. Patients with inadequate organ function were excluded. Tumor size was documented at baseline and after completion of neoadjuvant chemotherapy. After diagnostic biopsy, patients were given paclitaxel (100 mg/m2) weekly for 8 weeks. This was followed by breast conservative surgery or mastectomy (as per surgeon’s discretion) and adjuvant chemotherapy with 4 cycles of FEC (5-fluorouracil 500 mg/m2, epirubicin 90 mg/m2, cyclophosphamide 500 mg/m2), radiotherapy and hormone therapy (if indicated). The primary objectives included assessment of clinical and pathologic response after primary chemotherapy and to assess toxicity profile of weekly paclitaxel. Results: A total of 30 patients - stage IIA-2, stage IIB-1, stage IIIA-8, stage IIIB-18, stage IIIC-1 between the ages of 30–67 were included. All 30 patients were assessable for clinical response and 28 patients were assessable for pathologic response. A total of 239 out of planned 240 cycles were administered. Clinical complete response was seen in 12/30 patients and clinical partial response in 16/30 patients (overall response = 28/30). One patient each had stable and progressive disease. Complete pathologic response was observed in 4 patients. Two patients received second-line chemotherapy owing to suboptimal response. Side effects were mild in the form of myalgia, nausea and vomiting. Eight patients developed Grade I-II neuropathy and 1 patient developed Grade IV neuropathy. No incidence of neutropenic fever was noted during the weekly paclitaxel schedule. One patient suffered from myelotoxicity in the form Grade III leucopenia, Grade IV neutropenia and grade III thrombocytopenia. Conclusions: Single agent weekly paclitaxel is safe and effective as neoadjuvant chemotherapy in patients with LOBC and LABC with modest pathologic responses. No significant financial relationships to disclose.