Retrospective comparison of response rates and survival with neoadjuvant docetaxel versus anthracycline-based chemotherapy for locally advanced breast cancer patients

Abstract

e11564 Background: LABC is a major problem in our country comprising of ≥ 20% of all breast cancer patients. Neoadjuvant chemotherapy is now standard treatment for LABC but randomized trials have failed to show survival advantage. Methods: We retrospectively analyzed locally advanced breast cancer (stage III) patients who received neoadjuvant chemotherapy (NACT) from January 2000 to December 2008. Out of 3000 case records screened, 570 (19%) were LABC and 110/570 (19%) treatment-naïve patients started on NACT were analyzed. Ninety one (37 docetaxel [D], 54 anthracycline [A]) patients were eligible for response and survival analysis. Pathological CR (pCR) was defined as no evidence of malignancy in both breast and axilla. Survival curves generated using Kaplan-Meier method and survivals compared using log-rank test. Results: Median age of whole cohort was 45 years (range 25–68 years). Premenopausal were 42% and ER+ 49.5%. Most (90%) were T4 tumors and 70% were stage IIIB. Median number of preoperative cycles was 3 and 6 in D and A group. Overall clinical response rates for breast primary were 74.3% (CR 28.6%) and 53.7% (CR 16.7%, p=0.58) while for axilla ORR were 75.7% (51.4% CR) vs 54.8% (40.4% CR, p=0.77) respectively for D and A. Corresponding pCR rates were 19% vs 13% respectively. There was no significant difference in disease free (3 year 56.84% vs 61.16%, p=0.80) and overall survival (3 year 70% vs 78.5%, p=0.86) between two groups. Those who achieved pCR in both groups also had no survival advantage (p=0.34) over non achievers. There was no difference in pCR rates for ER+ vs ER- patients but ER+ patients had significantly higher DFS than ER- patients (p=0.05). Conclusions: Although pCR rates were higher with docetaxel based NACT, it did not translate into superior DFS/OS compared to anthracycline based chemotherapies. Achievement of pCR too, was not associated with any survival advantage. No significant financial relationships to disclose.