Lymphatic targeting chemotherapy for refractory lymph nodes in patients with breast cancer after neoadjuvant chemotherapy: Preliminary experience.

Abstract

e13010 Background: Primary systemic chemotherapy is increasingly used to downstage breast cancer. However, in some cases, it was observed that contrary to sufficient regression of cancer, the tumor-involved lymph nodes remained stable. In this study, we performed lymphatic targeting chemotherapy on patients with refractory nodes and evaluated its efficacy and safety. Methods: From October 2004 to August 2007, 318 node-positive breast cancer patients were submitted to three cycles of neoadjuvant chemotherapy. After two cycles, 72 patients showed responsive tumor but nonresponsive nodes. Of them, 42 received an additional subcutaneous injection of pegylated liposomal doxorubicin during the third cycle; the other 30 who refused to receive the targeting therapy were regarded as control. Results: Lymphatic targeting treatment substantially increased both clinical and pathological node response rate [62% (26/42) vs 13% (4/30) and 12% (5/42) vs 0 (0/30), respectively], and induced a higher apoptosis level of metastatic cells (median, 41% vs 6%), as compared with the control. Moreover, a higher disease-free survival was observed after a median follow-up of 4 years (69% vs 56%). Inflammatory reaction surrounding injection site was the most common side effect. Conclusions: Lymphatic chemotherapy has reliable efficacy and well-tolerated toxicity for breast cancer patients presenting refractory lymph nodes after neoadjuvant chemotherapy.