Analysis of neoadjuvant therapies in breast cancer with respect to pathological complete response, disease-free survival and overall survival: 15 years follow-up data from Kuwait.
OBJECTIVE
Optimizing neoadjuvant chemotherapy regimens is essential for achieving maximal pathological complete response (pCR) in patients with breast cancer. pCR is usually considered as a surrogate marker for survival. The aim of this study was to analyze pCR with respect to various neoadjuvant regimens and its effect on survival.


METHODS
This retrospective analysis included 377 patients with stages II and III breast cancer treated between 1998 and 2009 with neoadjuvant chemotherapy. Neoadjuvant regimens were analyzed with respect to pCR, disease-free survival (DFS) and overall survival (OS).


RESULTS
The median age of our population was 50 years with the majority being premenopausal and locally advanced. The overall pCR rate was 13.7% with higher rates seen in patients receiving combination of anthracyclines and taxanes (14.2%). The practice of sandwiching surgery and chemotherapy was inferior to true neoadjuvant chemotherapy of eight cycles. Addition of trastuzumab to Her2 positive patients resulted in higher pCR rates (P = 0.006). Achievement of pCR with neoadjuvant chemotherapy resulted in significantly higher DFS and OS.


CONCLUSIONS
pCR is associated with better survival in breast cancer patients receiving neoadjuvant chemotherapy. Initial anthracycline-based chemotherapy followed by non-cross-resistant taxane-based chemotherapy along with the addition of trastuzumab in Her2 positive patients might be the optimal neoadjuvant regimen in breast cancer patients.
Department of Medical Oncology, Kuwait Cancer Control Centre, Kuwait.
Yamini
Y
Krishnan
Department of Medical Oncology, Kuwait Cancer Control Centre, Kuwait.
Shafika
S
Al Awadi
Department of Medical Oncology, Kuwait Cancer Control Centre, Kuwait.
P S
PS
Sreedharan
Department of Medical Oncology, Kuwait Cancer Control Centre, Kuwait.
Susovana
S
Sujith Nair
Department of Medical Oncology, Kuwait Cancer Control Centre, Kuwait.
Sanjay
S
Thuruthel
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007730:Kuwait; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies
breast cancer; neoadjuvant chemotherapy; pathological complete response; trastuzumab