Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer in a Malaysian Tertiary Hospital

Introduction: Neoadjuvant chemotherapy for locally advanced breast cancer is given with the aim of shrinkingthe disease sufficiently for surgery. However, many clinical trials investigating neoadjuvant chemotherapyregimens were conducted for operable breast cancer. Methods and Materials: Patients with T3-4, N2 M0 breastcancer diagnosed between January 2005 and December 2008 and who received at least one cycle of neoadjuvantchemotherapy were eligible for this study. Thirty-four patients were identified from the Chemotherapy DaycareRecords and their medical records were reviewed retrospectively. The neoadjuvant chemotherapy regimenadministered was at the discretion of the treating oncologist. Breast tumour size and nodal status was assessedat diagnosis, at each cycle and before surgery.
Results: All 34 patients had invasive ductal cancer. The medianage was 52 years (range 27-69). 65% had T4 disease and 76% were clinically lymph node positive at diagnosis.The median size of the breast tumour at presentation was 80 mm (range 42-200 mm). Estrogen and progesteronereceptor positivity was seen in less than 40% and HER2 positivity, by immunohistochemistry, in 27%. Themajority (85%) of patients had anthracycline based chemotherapy, without taxanes. The overall response rate(clinical CR+PR) was 67.6% and pathological complete responses were apparent in two (5.9%). 17.6% ofpatients defaulted part of their planned treatment. Recurrent disease was seen in 44.1% and the median time torelapse was 11.3 months. The three year disease free and overall survival rates were 52.5% and 58% respectively.
Conclusion: Neoadjuvant chemotherapy for locally advanced breast cancer in a Malaysian setting confersresponse and pCR rates comparable to published clinical trials. Patients undergoing neoadjuvant chemotherapyare at risk of defaulting part of their treatment and therefore their concerns need to be identified proactivelyand addressed in order to improve outcomes.