Neoadjuvant chemotherapy with epirubicin and cyclophosphamide followed by docetaxel (ECT) in locally advanced and inflammatory breast cancer (BC): Saint Louis experience

Abstract

10729 Background: Neoadjuvant chemotherapy is increasingly used in locally advanced breast cancer ptes. We studied the histological response after neoadjuvant chemotherapy in ptes with locally advanced and inflammatory breast cancer. Methods: From 2003 to 2005, 50 ptes with locally advanced and inflammatory breast cancer received neoadjuvant chemotherapy (Epirubicin 75 mg/m2, Cyclophosphamide 750 mg/m2 (d1-q21, 4 courses (c)) followed by Docetaxel 100 mg/m2 (d1-q21, 4 c). All ptes had a surgical biopsy prior chemotherapy, initial conservative surgery was impossible. Clinical responses were evaluated by the same oncologist and the surgery slices reviewed by the same pathologist. Histological complete response is defined as no infiltrative and/or in situ tumor in the breast and negative lymph nodes. Results: Ptes characteristics: median age 50 y (30–74), 30 premenopausal ptes; T2: 5 ptes, T3: 24, T4: 21, median tumor size 60 mm; N0: 12, N1: 38, 11 ptes had inflammatory tumor. Histological features: 43 infiltrating ductal carcinoma, 7 infiltrating lobular carcinoma, SBR grade 1/2/3: 2/23/24; vascular embols (13 positive, 37 negative), RH+: 28 ptes (16 RE+/RP+; 12 RE+/RP-) and 22 RH-, C-erb2 status (43 negative and 7 positive). All the ptes received 8 courses of chemo. Clinical response at 8 c: 22 (44 %) ptes had a complete response, 14 (32%) partial response, 9 (20%) stable disease, 4 ptes (8%) had progressive disease, 1 was not evaluated. 42 ptes had breast surgery, 5 are too early, 2 progressed and received a second line chemo, 1 refuse surgery. Out of 42 operated ptes, 37 had mammectomy, 5 tumorectomy, 39 had axillary dissection. Histological response: 7 ptes had a complete pathological response (pCR) (17 %), 3 had pCR with persistant in situ carcinoma (7%), 32 ptes (76%) had persistant infiltrative carcinoma [histological response >50% 14 ptes (33%), <50% 18 ptes (43%)]; 11 (26%) ptes had negative lymph nodes, 28 (66 %) had positive lymph nodes [10 1–3 N+; 18 ≥ 4 N+]. Conclusion: In this population with a large amount of T3-T4 (median size 60mm) and inflammatory cancers the complete histological response rate of 17% (24% with in situ) is close to the series with smaller tumors. The rate of breast conservation is low (12%). No significant financial relationships to disclose.