Taxane and Anthracycline Based Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer : Institutional Experience

Background: The aim of this study was to assess the response rates (clinical and pathological ) with docetaxeland epirubicin combination chemotherapy and its effect on outcome. Materials and
Methods: We retrospectivelyanalysed locally advanced breast cancer (LABC) patients who received NACT from January 2008 to December2012 in our tertiary care centre. LABC constituted 37% of all breast cancer cases and 120 patients fulfilled theeligibility 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-flurouracil600 mg/m², epirubicin 75 mg/m², cyclophosphamide 600 mg/m² followed by 4 cycles of docetaxel 85 mg/m2).
Results: The median age was 47 years (range 23-72). Ninety six ( 80 %) had T4 disease and 90% had clinicallypalpable lymph nodes at diagnosis. The median size of primary tumor at presentation was 5.9 cm. Hormonereceptor positivity was seen in 55% and HER2/neu positivity, in 25%. Triple negative breast cancers constituted25 % of the cases. The overall clinical response rate ( complete or partial ) was 85% and pathological completeresponses 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 torelapse was 20 months and the 3 year relapse free and overall survival rates were 50% and 70% respectively.
Conclusions: LABC constituted 37% of all breast cancer cases at our institute. With NACT, pCR was seenin 15% of the cases. Sequential chemotherapy was better tolerated than concurrent anthracyline and taxanechemotherapy with a similar pCR.