Abstract
ABSTRACTObjective:To evaluate the complete pathologic response attained by patients diagnosed with locally advanced breast cancer submitted to neoadjuvant chemotherapy based on the doxorubicin/ cyclophosphamide regimen followed by paclitaxel.Methods:A retrospective cohort of patients with locally advanced breast cancer, admitted to the Hospital de Câncer de Barretos between 2006 and 2008 submitted to the doxorubicin/cyclophosphamide protocol followed by paclitaxel (4 cycles of doxorubicin 60mg/m2 and cyclophosphamide 600mg/m2 every 21 days; 4 cycles of paclitaxel 175mg/m2 every 21 days). The following variables were assessed: age, menopause, performance status, initial clinical staging, anthropometric data, chemotherapy (dose – duration), toxicity profile, post-treatment staging, surgery, pathologic complete response rate, disease-free survival, and pathological characteristics (type and histological degree, hormonal profile and lymph node involvement). Statistical analysis was performed using a 5% level of significance.Results:Of the 434 patients evaluated, 136 were excluded due to error in staging or because they had received another type of chemotherapy. Median age was 50 years, all with performance status 0-1. Median initial clinical size of tumor was 65mm and the median final clinical size of the tumor was 22mm. Fifty-one (17.1%) patients experienced a pathologic complete response. Those with a negative hormonal profile or who were triple-negative (negative Her-2 and hormonal profile) experienced a favorable impact on the pathologic complete response.Conclusion:Neoadjuvant chemotherapy with doxorubicin/ cyclophosphamide followed by paclitaxel provided a pathologic complete response in the population studied in accordance with that observed in the literature. Triple-negative patients had a greater chance of attaining this response.
Highlights
Breast cancer is the second most frequent cancer worldwide and the first among women, excluding non-melanoma skin cancer[1]
According to data from the Instituto Nacional de Câncer (INCA) for 2012, the estimate was 52,680 new breast cancer cases diagnosed in Brazil, and 15,620 of which would occur in the State of São Paulo, where the incidence rate is 71.7/100 thousand women[2]
The objective of this study was to retrospectively evaluate the pathological complete response achieved by patients with locally advanced breast cancer exposed to neoadjuvant chemotherapy with a sequential regimen based on anthracycline and taxane, and to correlate this response with clinical factors and biological markers
Summary
Breast cancer is the second most frequent cancer worldwide and the first among women, excluding non-melanoma skin cancer[1]. According to data from the Instituto Nacional de Câncer (INCA) for 2012, the estimate was 52,680 new breast cancer cases diagnosed in Brazil, and 15,620 of which would occur in the State of São Paulo, where the incidence rate is 71.7/100 thousand women[2]. The definition of locally advanced breast cancer (LABC) is classically restricted to stage III. This type of patients, along with a change in TNM (Tumour, Node and Metastasis) staging in 2002, which established stage IIIC as locally advanced, and of the inclusion of stage II patients (T3N0 or with T2>3cm) within this context, has made difficult the interpretation of results in neoadjuvant chemotherapy studies (NAC)(3,4). Neoadjuvant chemotherapy has some potential advantages: it treats the systemic micrometastatic disease from the beginning; reduces the tumor load; increases the rate of conservative surgery; allows the in vivo evaluation of sensitivity to chemotherapy (CT) and a rapid modification of the therapeutic regimen, if necessary[6]
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