Background: Locally advanced breast cancer (LABC) refers to
a heterogeneous group of locally advanced non metastatic group of breast
cancer. Primary systemic chemotherapy which forms the
prime modality in LABC management has several advantages.
Aim: To assess the response and survival of locally advanced breast cancer patients receiving Primary Systemic Chemotherapy (PST) with Anthracycline based combination chemotherapy in Indian setting.
Methods: From January 2004 to December 2005 seventy-five patients who satisfied the inclusion criteria were included in this study. Prospectively observed locally advanced breast cancer patients who were primarily inoperable and who received Anthracycline based neoadjuvant chemotherapy. Chemotherapy schedules used were FAC (5-Fluorouracil 500 mg/m2, Doxorubicin 50 mg/m2 and Cyclophosphamide 500 mg/m2) and FEC (5-Fluorouracil 500 mg/m2, Epirubicin 100mg/m2 and Cyclophosphamide 500 mg/m2). Tumour response was assessed both clinically and pathologically. Clinical complete response (cCR), partial response (PR), stable disease (SD) and pathological complete response (pCR) were assessed. 5 year overall survival (O.S) & disease free survival (DFS) were analyzed using Kaplan Meier survival analysis.
Results: 94% patients who were initially inoperable became operable after PST and only 6% remained inoperable. A radical MRM with axillary clearance was achieved in 70.4% while simple mastectomy with axillary dissection in 22.5%. Microscopic surgical clearance achieved in 85.9% of cases. The objective clinical tumour response rate in our study was 78.9% with cCR of 11.3%, PR of 67.6%. The pCR is 7.5% in our study. 5 yr O.S and DFS were 67.92% and 62.21% respectively.
Conclusions: Anthracycline based chemotherapy is an excellent schedule in Neoadjuvant setting in LABC in Indian patients. But to improve the O.S, DFS and pCR addition of agents like Taxanes and their sequencing must be explored. RCTs addressing these issues are warranted especially in countries like India were percentage of LABC is high and tumour biology is aggressive.