title: Clinical and pathologic response following taxane based neoadjuvant chemotherapy in locally advanced breast cancer patients in a tertiary care centre in India.
abstract: BACKGROUND
  Neoadjuvant chemotherapy has become the standard recommendation in the management of patients with locally advanced breast cancer. At present anthracycline based regimen such as CAF (cyclophosphamide, adriamycin and 5-FU) is widely used in clinical practice. The introduction of taxanes has revolutionized this field because of superior results.
  
  
  OBJECTIVE
  This study is designed to compare the efficacy of paclitaxel plus doxorubicin regimen and CAF (cyclophosphamide, doxorubicin and 5-fluorouracil) regimen as neoadjuvant treatment of locally advanced breast cancer and to compare their toxicity profiles and also to correlate the hormonal receptor status in predicting response to the NACT.
  
  
  METHODS
  In this prospective study, 101 patients with newly diagnosed locally advanced breast cancer were randomized to receive either CAF or Paclitaxel/adriamycin as NACT for three cycles. The response was assessed objectively using CT scans and applying RECIST criteria. The patients were monitored for hematologic, cardiac and other minor toxicities.
  
  
  RESULTS
  There was a significantly increased complete and objective response seen in the AP group when compared to CAF group (24% and 58% in the AP group versus 7.8% and 39.2% in the CAF group, P value 0.0313 for complete response). The pCR rate was also significantly higher in the AP group compared to CAF group. (20.93% versus 4.34%, P value 0.0237). There was no significant difference between the groups with respect to cardiotoxicity and hematotoxicity. Patients with ER negative tumors have responded well to neoadjuvant chemotherapy better than ER positive patients. (Objective response 62.8% vs. 40%, P - 0.0473).
  
  
  CONCLUSIONS
  Based on these results, taxane based regimen such as Paclitaxel/adriamycin can be recommended as a first line neoadjuvant regimen in patients with locally advanced breast cancer.
authors.affiliation: Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: Masillamany
authors.initials: M
authors.lastname: Sivasanker
authors.affiliation: Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: S C
authors.initials: SC
authors.lastname: Sistla
authors.affiliation: Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: S Ali
authors.initials: SA
authors.lastname: Manwar
authors.affiliation: Department of Radiotherapy, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: S
authors.initials: S
authors.lastname: Vivekanandam
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007194:India; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D043823:Taxoids / Q000627:therapeutic use*; D062606:Tertiary Care Centers
chemical_list: D043823:Taxoids