Influence of Pathological and Biological Profile of Breast Cancer on the Outcome of Neoadjuvant Chemotherapy
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- Category: Vol. 85, June 2017
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Influence of Pathological and Biological Profile of Breast Cancer on the Outcome of Neoadjuvant Chemotherapy, MONA A. ABUL-ENEIN, INAS A. KORIEN, SAYED A. MAREIY, MOHAMED A. HASSAN and MOHAMED A. ABO EL-KASSEM
Abstract
Background: Locally Advanced Breast Cancer (LABC) is a very common clinical presentation especially in developing countries (30% to 60%). Neoadjuvant Chemotherapy (NAC) became an essential part of the multidisciplinary management of LABC, probably prolonging the Disease-Free Survival (DFS) and Overall Survival (OS) especially if pathological Complete Remission (pCR) was achieved, and increasing breast conservation rate.
Patients and Methods: The current prospective cohort study included 80 presented at Kasr El-Aini Center of Clinical Oncology & Nuclear Medicine (NEMROCK) during the period between August 2013 and March 2015 with LABC (stage IIB-IIIC) who were treated by NAC (sequential anthra-cyclins and taxanes ± Trastuzumab). The primary endpoint was pCR rate across different biological breast subtypes. The patients were then followed for a median of 15.3 months.
Results: After a median follow-up of 15.3 months during which a total of 73 patients (91.3%) were subjected to surgery after completion of the full course of chemotherapy. The objective clinical response was 86.7%, 93.5%, 82.4% and 73.3% in luminal A, B, Her2-enriched and TNBC respectively. The rate of breast conserving surgery was 35.7%, 16%, 13.3% and 30.7% in luminal A, B, Her2 enriched and TNBC respec-tively. A total of 16 patients (21.9%) achieved pCR. The rate of pCR was 14.3%, 32.3%, 40% and 15.4% in luminal A, B, Her2 enriched and TNBC respectively. The 2-year DFS was 93.8%, 93.5%, 55.6% and 86.7% in luminal A, B, Her-2 enriched and TNBC respectively (p-value: 0.003). Also, the 2-year DFS was 100%, 89.1%, 81.5% and 0% in stage II B, IIIA, IIIB and IIIC respectively (p-value: 0.020).
Conclusion: Neoadjuvant chemotherapy should be the treatment of choice in all biological subtypes of LABC. Intensification of the chemotherapy regimens for LABC with inclusion of trastuzumab in HER2 positive tumors is essential to improve the treatment outcome. Identifying which tumors are most likely to respond to specific agents and regimens could significantly improve prognosis.