Outcome and response rate in post neoadjuvant chemotherapy for breast cancer in a tertiary hospital in Malaysia
DOI:
https://doi.org/10.18203/2349-2902.isj20233331Keywords:
Breast cancer, Neoadjuvant chemotherapy, Outcome, Disease free survival, RecurrenceAbstract
Background: The use of preoperative chemotherapy also increased the rate of breast conserving surgery in breast cancer. This study aims to assess the type of chemotherapy and biological markers that associated with pathological complete response in our population.
Methods: This is a data analysis involving breast cancer patients confirmed pathologically that underwent neoadjuvant chemotherapy in Hospital Raja Perempuan Zainab II from January 2018 to December 2021. Retrospective sampling was done using Sistem Pengurusan Pesakit (SPP) which is a hospital-generated database. All patients were given standard chemotherapy regimens.
Results: A total of 59 patients enrolled in this study. Half of the patients were luminal A (48%), luminal B and triple negative breast cancer (TNBC) were both 23%. All patients received antracyclin as neoadjuvant regime and 54% had a combination with Docetaxel. Only 1 patient achieved pCR which was TNBC, given Antracyclin + Taxane regime. Tumour reduction >90% highest in TNBC group and using FEC regime. Factors associated with survival were age and miller payne grade. The only pCR was achieved in triple negative breast cancer as being showed by previous study. Tumour loss with more than 30% is equal comparing Antracyline only group and Antracyline + Taxane group.
Conclusions: Antracyline + Taxane regime chemotherapy is still the regime of choice for neoadjuvant chemotherapy in breast cancer. Triple negative breast cancer patients should receive preoperative chemotherapy as they will have a higher rate of pCR.
Metrics
References
De Lena M, Varini M, Zucali R, Rovini D, Viganotti G, Valagussa P, et al. Multimodal treatment for locally advanced breast cancer. Result of chemotherapy-radiotherapy versus chemotherapy-surgery. Cancer Clin Trials. 1981;44:229-36.
Nes JGH, Putter H, Julien JP. Preoperative chemotherapy is safe in early breast cancer, even after 10 years of follow-up; clinical and translational results from the EORTC trial 10902. Breast Cancer Res Treat. 2009;115:101-13.
Fisher ER, Wang J, Bryant J, Fisher B, Mamounas E, Wolmark N. Pathobiology of preoperative chemotherapy. Cancer. 2002;95:681-95.
Mamounas EP, Anderson SJ, Dignam JJ. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol. 2012;30(32):3960-6.
Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. The Lancet. 2014:384(9938):164-72.
Rastogi P, Anderson SJ, Bear HD, Geyer CE, Kahlenberg MS, Robidoux A, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008;26:778-85.
Keune JD, Jeffe DB, Schootman M, Hoffman A, Gillanders WE, Aft RL. Accuracy of ultrasonography and mammography in predicting pathologic response after neoadjuvant chemotherapy for breast cancer. Am J Surg. 2010;199(4):477-484.
Sudhir R, Koppula VC, Rao TS, Sannapareddy K, Rajappa SJ, Murthy SS. Accuracy of digital mammography, ultrasound and MRI in predicting the pathological complete response and residual tumor size of breast cancer after completion of neoadjuvant chemotherapy. Indian J Cancer. 2022;59(3):345-53.
LeVasseur N, Sun J, Gondara L, Diocee R, Speers C, Lohrisch C, et al. Impact of pathologic complete response on survival after neoadjuvant chemotherapy in early-stage breast cancer: a population-based analysis. J Cancer Res Clin Oncol. 2020;146(2):529-36.
Broglio KR, Quintana M, Foster M, Olinger M, McGlothlin A, Berry SM, et al. Association of Pathologic Complete Response to Neoadjuvant Therapy in HER2-Positive Breast Cancer With Long-Term Outcomes: A Meta-Analysis. JAMA Oncol. 2016;2(6):751-60.
Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol. 2018;19(1):27-39.
Masood S. Neoadjuvant chemotherapy in breast cancers. Women’s Health. 2016;12(5):480-91.
Martin M. Docetaxel, doxorubicin and cyclophosphamide (the TAC regimen): an effective adjuvant treatment for operable breast cancer. Womens Health (Lond). 2006;2(4):527-37.
Martin M, Pienkowski T, Mackey J, Pawlicki M, Guastalla JP, Weaver C, et al. Breast Cancer International Research Group 001 Investigators. Adjuvant docetaxel for node-positive breast cancer. N Engl J Med. 2005;352(22):2302-13.
Saadatmand S, Bretveld R, Siesling S, Tilanus-Linthorst MMA. Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173797 patients. BMJ. 2015;351:h4901.
Pierga JY, Robain M, Jouve M, Asselain B, Diéras V, Beuzeboc P, et al. Response to chemotherapy is a major parameter-influencing long-term survival of metastatic breast cancer patients. Ann Oncol. 2001;12(2):231-7.