Abstract
From January 1, 2008 to March 31, 2010, 101 patients with stage II-III breast cancer were enrolled in this study and subjected to an anthracycline-based neoadjuvant chemotherapy regimen with or without docetaxel. Surgery was performed after 2-6 cycles of chemotherapy, and the clinical response was determined by pathological and histochemical assessments. The clinical response rate, as indicated by complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD), were 6.9, 52.5, 36.6, and 4.0%, respectively. A multivariable correlation analysis indicated that the overall clinical response rate correlated with the number of metastatic lymph nodes, number of chemotherapy cycles, and vessel invasion status. Importantly, the CR rate was only associated with the number of chemotherapy cycles. Nonparametric tests failed to detect a correlation between HER2 or Topo IIα status and clinical response to neoadjuvant chemotherapy in these patients. When they were stratified by HER2 or HR status, for HER2-positive patients the CR rate was associated with vessel invasion and Topo IIα status. Based on our findings, we propose that HR, HER-2 and Topo IIα are not putative predictive biomarkers of chemotherapy outcome for breast cancer patients. Topo IIα expression level was only inversely correlated with CR rate among HR-positive patients. Importantly, the achievement of CR was largely related to the number of chemotherapy cycles.
Highlights
Neoadjuvant chemotherapy, which was originally established by Haagnesen and Stout in the 1970s, has been increasingly used in the management of patients with large, operable, and locally advanced breast cancers
Invasive breast ductal carcinoma constitutes 75% of all breast cancer cases, and neoadjuvant chemotherapy is generally applied to patients in stage II and III of the disease, which ensured equality of the subjects enrolled and strengthened the credibility of the study
Another obvious feature was that the majority of patients were diagnosed with relatively advanced stage breast cancer, with an average duration of 18.01 ± 3.97 months between the detection of a breast lump and the time of enrollment, which was largely due to the fact that most patients were from rural areas of China
Summary
Neoadjuvant chemotherapy, which was originally established by Haagnesen and Stout in the 1970s, has been increasingly used in the management of patients with large, operable, and locally advanced breast cancers. This treatment is administered with the goal of downstaging and avoiding a mastectomy. A large number of studies have since explored the clinical significance of neoadjuvant chemotherapy in breast cancer treatment, including two well-known large-scale clinical trials, namely NSAPB B18 and B27 (Wolmark et al, 2001; Rastogi et al, 2008). ER status has been considered predictive of pCR in patients receiving neoadjuvant chemotherapy for operable and locally advanced breast cancer. The findings presented here provide useful information for the current treatment selection criteria and may potentially provide a substantial benefit for the patients
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