Abstract
The aim of this study was to assess the response rates (clinical and pathological ) with docetaxel and epirubicin combination chemotherapy and its effect on outcome. We retrospectively analysed locally advanced breast cancer (LABC) patients who received NACT from January 2008 to December 2012 in our tertiary care centre. LABC constituted 37% of all breast cancer cases and 120 patients fulfilled the eligibility criteria. The regimens used for NACT were, six cycles of DEC (docetaxel 75 mg/m2, epirubicin 75 mg/ m2, cyclophosphamide 500 mg/m2 on Day 1, 3 weekly) and a sequential regimen (4 cycles of FEC, 5-flurouracil 600 mg/m2, epirubicin 75 mg/m2, cyclophosphamide 600 mg/m2 followed by 4 cycles of docetaxel 85 mg/m2). The median age was 47 years (range 23-72). Ninety six ( 80 %) had T4 disease and 90% had clinically palpable lymph nodes at diagnosis. The median size of primary tumor at presentation was 5.9 cm. Hormone receptor positivity was seen in 55% and HER2/neu positivity, in 25%. Triple negative breast cancers constituted 25 % of the cases. The overall clinical response rate ( complete or partial ) was 85% and pathological complete responses were obtained in 15%. Four cases defaulted, 5 patients died of treatment related toxicity and 15% developed febrile neutropenia on DEC. The median duration of follow up was 22 months. The median time to relapse was 20 months and the 3 year relapse free and overall survival rates were 50% and 70% respectively. LABC constituted 37% of all breast cancer cases at our institute. With NACT, pCR was seen in 15% of the cases. Sequential chemotherapy was better tolerated than concurrent anthracyline and taxane chemotherapy with a similar pCR.
Highlights
Breast cancer is the most common cancer among females in India, as per urban cancer registries
The regimens used for Neoadjuvant chemotherapy (NACT) were, six cycles of DEC and a sequential regimen (4 cycles of FEC, 5-flurouracil 600 mg/m2, epirubicin 75 mg/m2, cyclophosphamide 600 mg/m2 followed by 4 cycles of docetaxel 85 mg/m2)
Chemotherapy regimens were used in combination (DEC, docetaxel 75 mg/m2, epirubicin 75 mg/m2 and cyclophosphamide 500 mg/m2 with growth factor support, 3 weekly) or sequentially
Summary
Breast cancer is the most common cancer among females in India, as per urban cancer registries. LABC refers to large breast tumors (>5 cm) associated with either skin/ chest wall involvement or with fixed axillary lymph nodes or spread to ipsilateral internal mammary or supraclavicular nodes. It accounts for 10-20% of all breast cancers in the west and the long term outcome is around 60-70% in different series (Giordano, 2003). Previous studies have reported superiority of anthracylinee based chemotherapy over CMF (cyclophosphamide, methotrexate and 5- flurouracil) regimen, further, taxanes have been extensively used either alone or in combination with anthracyclines to improve outcome in patients with LABC (Bull et al, 1978; Early Breast Cancer Trialists Collaborative Group, 1998; Yao et al, 2012). Sequential chemotherapy was better tolerated than concurrent anthracyline and taxane chemotherapy with a similar pCR
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