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Outcome of combined modality treatment including neoadjuvant chemotherapy of 128 cases of locally advanced breast cancer: Data from a tertiary cancer center in northern India Raina V, Kunjahari M, Shukla N K, Deo S, Sharma A, Mohanti B K, Sharma D N - Indian J Cancer
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ORIGINAL ARTICLE
Year : 2011  |  Volume : 48  |  Issue : 1  |  Page : 80-85
 

Outcome of combined modality treatment including neoadjuvant chemotherapy of 128 cases of locally advanced breast cancer: Data from a tertiary cancer center in northern India


Department of Medical Oncology, Surgical Oncology, and Radiation Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi -29, India

Date of Web Publication 10-Feb-2011

Correspondence Address:
V Raina
Department of Medical Oncology, Surgical Oncology, and Radiation Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi -29
India
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DOI: 10.4103/0019-509X.75838

PMID: 21248440

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 » Abstract  

Background: Breast cancer is now the most common cancer in many parts of India and the incidence varies from 12 to 31/100000, and is rising. Locally advanced breast cancer (LABC) accounts for 30 - 35% of all cases of breast cancers in India. LABC continues to present a challenge and imposes a major health impact in our country. Materials and Methods: We carried out a analysis of our LABC patients who received neoadjuvant chemotherapy (NACT) at our hospital over a 10-year period, from January 1995 to December 2004. We analyzed the response to NACT, disease-free survival (DFS), and overall survival (OS). Results: Patients with stages IIIA, IIIB, and IIIC were included. LABC comprised of 26.24% (609 patients) of new patients. One hundred and twenty-eight (31.1%) patients received NACT. Median age was 48 years and estrogen receptor was positive in 64%. Chemotherapy protocol was an FEC (5-Fluorouracil, Epirubicin, Cyclophosphamide) regimen in the following doses: Cyclophosphamide 600 mg/m2, 5-FU 600 mg/m2, and Epirubicin 75 mg/m2 given every three weeks, six doses, followed by modified radical mastectomy (MRM) and locoregional radiotherapy. The overall response rate (complete response (CR) + partial response (PR)) was 84.4%, clinical CR (cCR) was 13.3% and pathological CR (pCR) was 7.8%. Median DFS and OS were 33 and 101 months, respectively. The disease-free survival (DFS) and overall survival (OS) at five years were 41 and 58%, respectively. Conclusions: This study analyzes the outcome in patients who received NACT, in the largest number of LABC patients from a single center in India, and our results are comparable to the results reported from other centers.


Keywords: Locally advanced breast cancer, neoadjuvant chemotherapy, combined modality treatment


How to cite this article:
Raina V, Kunjahari M, Shukla N K, Deo S, Sharma A, Mohanti B K, Sharma D N. Outcome of combined modality treatment including neoadjuvant chemotherapy of 128 cases of locally advanced breast cancer: Data from a tertiary cancer center in northern India. Indian J Cancer 2011;48:80-5

How to cite this URL:
Raina V, Kunjahari M, Shukla N K, Deo S, Sharma A, Mohanti B K, Sharma D N. Outcome of combined modality treatment including neoadjuvant chemotherapy of 128 cases of locally advanced breast cancer: Data from a tertiary cancer center in northern India. Indian J Cancer [serial online] 2011 [cited 2014 Mar 7];48:80-5. Available from: http://www.indianjcancer.com/text.asp?2011/48/1/80/75838



 » Introduction   Top


Breast cancer is now the most common cancer in many parts of India and the incidence varies from 12 to 31/100000, and is rising.[1] Locally advanced breast cancer (LABC) refers to large breast tumors (> 5 cm) associated with either skin or chest wall involvement or with fixed axillary lymph nodes or with involvement of the ipsilateral internal mammary or supraclavicular nodes.[2] LABC accounts for 10 - 20% in the West[3] while in India it accounts for 30 - 35% of all cases.

Locally Advanced Breast Cancer (LABC) poses a significant clinical challenge. With the broad spectrum of presentations, survival rates for LABC vary significantly among the series, reflecting institutional differences in therapeutic policies and patient selection. Although some series report five-year survival rates of greater than 70%, [4],[5] these series exclude patients with inflammatory disease, the most aggressive form of non-metastatic breast cancer. Overall the results of the treatment of LABC patients are dismal and no more than 30 - 40% of the patients are expected to be long-term survivors.[6],[7],[8],[9],[10] Advanced stage of breast cancer and poor results of treatment represents a major public health problem of our country.

The present standard of treatment for LABC is still evolving. In the past decade anthracycline-based chemotherapy in the neoadjuvant setting followed by surgery and locoregional radiotherapy, followed by hormonal therapy in hormone receptor positive patients, has been the standard. Taxanes are under intense investigation. [11],[12] Combined or sequential use of anthracyclines and taxanes are both acceptable. Capecitabine and Gemcitabine have been recently incorporated into trials assessing NACT [13],[14]

The first report of the use of induction chemotherapy for LABC was published in the 1970s. [15] The administration of systemic chemotherapy prior to local therapy is advantageous for women with locally advanced breast cancer, as it can render inoperable tumors resectable and can increase the rates of breast conservative surgeries. [16],[17],[18],[19] Induction chemotherapy also has a theoretical advantage of the early initiation of systemic therapy, delivery of drugs through intact vasculature, in vivo assessment of the response to therapy, and the opportunity to study the biological effects of chemotherapy. First large trial to compare neoadjuvant with adjuvant chemotherapy, the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-18, [20] demonstrated that neoadjuvant chemotherapy produces a significant clinical and complete response rate, pathological complete response rates, as well as increased rates of breast conserving surgeries. Although no significant difference was noted in terms of overall survival and disease free survival, pathological CR was correlated with long-term survival.

In view of the major health impact of LABC and lack of adequate information regarding its clinical outcome, neoadjuvant chemotherapy, and its response rate, we carried out an analysis of our LABC patients who received induction chemotherapy.

The aim of this study was to analyze the response to neoadjuvant chemotherapy (NACT) and the outcome (DFS and OS) of Locally Advanced Breast Cancer patients who received NACT at our hospital over a 10-year period. (January 1995 - December 2004)


 » Materials and Methods   Top


This is a study of LABC patients who received NACT at our hospital over a 10-year period (January 1995 - December 2004).

Inclusion criteria

  1. LABC: Stages included were IIIA, IIIB, and IIIC (TNM staging was done according to AJCC 2002 revision).
  2. Adequate treatment at the Institute Rotary Cancer Hospital (IRCH) was considered when patients received a complete set of treatments as planned, at baseline, and at least three cycles of chemotherapy had been completed, except for those who had toxicity to chemotherapy and could not complete the planned treatment.


Response assessment after neoadjuvant chemotherapy

Response to neoadjuvant chemotherapy and the clinical size of the primary breast tumor and axillary nodes were determined prior to chemotherapy and prior to surgery

Clinical complete response

Disappearance of all known disease at primary sites and nodes.

Clinical partial response

At least a 50% reduction in bi-dimensional tumor size of all lesions added together, with no appearance of new lesions.

Clinical stable disease

If any composite lesion increased by lesser than 25% and no new lesion appeared.

Pathological complete response

If the mastectomy specimen did not reveal any histological evidence of invasive carcinoma in the breast or axilla.

Definitions outcome data used in the present study

Disease free survival


From the time of surgery to the last follow-up or development of recurrence or death.

Overall survival

From the date of diagnosis to the date of last follow up / death / lost to follow-up

Chemotherapy

FEC


Most frequently used chemotherapy regimen in the neoadjuvant setting

Doses

5 - FU- 600 mg/m2 iv (D1)

Epirubicin- 75 mg/m2 iv infusion (D1) over 60 minutes

Cyclophosphamide- 600 mg/m2 iv infusion (D1) over 30 minutes

Cycles repeated every three weeks for a total of six cycles

Statistical evaluation

For survival function, the Kaplan Meier method was used. The log-rank test was used for comparison between two survivals. The t-Test or Mann Whitney test was applied to compare DFS and OS (continuous variable) wherever applicable.


 » Results   Top


Outcome analysis was conducted on patients registered from January 1995 to December 2004, and follow-up was carried out till July 2009, with a median follow-up at 31 months (range 7 - 148 months). Out of a total of 2321 breast cancer cases, where complete staging workup was available, 609 (26.24%) patients had LABC. One hundred and twenty-eight (31.1%) patients received neoadjuvant chemotherapy. This is the analysis of those patients.

Median age at presentation was 48 years (Range = 22 - 85 years); 43.5% of our patients were premenopausal. Median duration of symptoms was five months (Range = 1 - 60 months) and the lump was the most common presenting feature. Skin involvement was observed in 63% of the patients.

One hundred and twenty-eight patients received neoadjuvant chemotherapy (NACT); this constituted 31.1% of the LABC patients. The overall clinical response rate of NACT was 84.4% with 13.3% CR and 71.1% PR; 7.8% of the patients achieved pathological CR (pCR) [Table 1]. The most frequently used chemotherapy regimen was FEC (77.3%) [Table 1]
Table 1 :Neoadjuvant chemotherapy (NACT) and NACT response


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Modified Radical Mastectomy (MRM) was performed on 91.4% of the patients. In the remaining patients, surgery could not be performed mainly because of progressive disease during chemotherapy and those patients remained inoperable. Infiltrating ductal carcinoma was the most common (95.1%) histological type.

The median number of identified axillary lymph nodes was 11 with a range from 1 to 29. The median number of positive axillary lymph nodes was two (range 0 - 20). This is obviously underestimated, due to prior chemotherapy. The estrogen receptor status was positive in 64% of the patients, and information on the Her2 neu status was incomplete.

Median DFS was 33 months and OS was 101 months, respectively [Figure 1] and [Figure 2], [Table 2]. The DFS and OS at five years were 41 and 58%, respectively [Table 2].
Table 2 :DFS and OS of all LABC patients who received NACT


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Figure 1 :Kaplan Meier Survival curve for disease free survival of locally advanced breast cancer patients who received neo adjuvant chemotherapy.

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Figure 2 :Kaplan Meier Survival curve for overall survival of locally advanced breast cancer patients who received neo adjuvant chemotherapy.

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When survival analysis was performed with regard to NACT response, we observed that the responding group (CR + PR) had a median DFS of 44 ± 11 months in comparison to 13 ± 3 months in the non-responding group (SD + PD). This difference in DFS was statistically significant (p = 0.003) [Table 3], [Figure 3]. The median OS was 101 months in the responding group, however, the median had not been reached in the non-responding group. This difference in OS was also statistically significant (P = 0.03) [Table 4], [Figure 4]
Table 3 :Mean and median DFS of NACT responding (CR + PR) and non-responding (SD + PD) patients and their comparisons

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Table 4 :Mean and median OS of NACT responding (CR + PR) and non-responding (SD + PD) patients and their comparisons

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Figure 3 :Kaplan Meier Survival curve for disease free survival of neoadjuvant chemotherapy responding and non-responding locally advanced breast cancer patients.

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Figure 4 :Kaplan Meier Survival curve for overall survival of neoadjuvant chemotherapy responding and non-responding locally advanced breast cancer patients.

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 » Discussion   Top


There is paucity of data with respect to the actual prevalence of locally advanced breast cancer in India. There is also a paucity of information regarding the treatment outcome of our LABC patients.

The median age at presentation is 48 years (range 22 - 85 years); significantly lower than the western figures, but similar to other Indian figures. In an early breast cancer study in India the median age was 47 years as reported by Raina et al.[21] Segal et al. reported from North America that the median age of LABC patients was 57 years (Range = 28 - 88 years). [22] In Turkey, the median age of LABC patients was 47 years (range = 17 - 74 years). [23]

Premenopausal patients constituted 43.5% of all LABC cases in the present study. In the randomized study on operable LABC by Deo et al., premenopausal patients were 40 and 50% in two arms of the study. [24] Forty-eight percent of the cases were premenopausal in a study on LABC patients in Italy. [25] A study from North America reported that 38% of LABC patients were premenopausal. [22]

Sixty-four percent of the cases were Estrogen receptor (ER) positive. In an earlier study by Raina et al., on Indian patients, the ER positivity was 50.5%. [26] Redkar et al. reported 43.9% ER positivity in breast cancer patients by enzyme immunoassay. [27] Western studies reported ER positivity in 60 - 80% of the patients. The differences in ER status in Indian and Caucasian patients could be due to lower average age at presentation or racial differences.

Neoadjuvant chemotherapy was given in 31.1% of the cases and FEC was the most frequently used regimen (77.3%). Clinical CR was observed in 13.3% in the NACT group, with an overall response rate of (CR + PR) 84.4%. Pathological CR (pCR) was seen in 7.8% of the cases. An earlier Indian study showed an overall RR of 62% with 4% pCR. [24] A Study from Turkey reported an overall clinical response of 88% (CR 14.9% and PR 73%). [23] Hurley et al. reported 17% pCR in LABC patients with Docetaxel, Cisplatin, and Trastuzumab therapy. [28] In a study by Baldini et al., the pCR rate was 3.3% with standard CEF. [25] Kuerer et al. reported a pCR rate of 12% with four courses of FAC chemotherapy in the neoadjuvant setting [29] . Other studies reported a response rate of 60 - 93% including 10 - 20% CRs. A relatively lower pCR rate in the present study, in comparison to some other studies, was due to a majority of our patients receiving anthracycline-based chemotherapy in contrast to these studies, which used taxanes. [28]

In the present study, the neoadjuvant chemotherapy responding group (CR and PR) had significantly better survival than the non-responding group (SD and PD). Similar observation was also reported by others. Patients achieving CR had a five-year DFS and OS of 75 and 88%, respectively, with PR intermediate prognosis, with no response and very poor survival, in the study by Deo et al.[24] Patients were with pCR OS 100% and without pCR the OS was 83%, in four-year in the study by Hurley et al.[28] Eltahir et al. reported a five-year probability survival of 74% in patients who achieved CR with NACT and 36% in patients who achieved PR.[30]

In conclusion, LABC constitutes 26.24% (609) of all breast cancers during this 10-year period. This study analyzes the outcome of patients who received NACT in the largest number of LABC patients from a single center in India and our results are comparable with the results reported from other centers.

 
 » References   Top

1. Two-year Report of the Population Based Cancer Registries: 1999-2000. National Cancer Registry Programme (Indian Council of Medical Research).  Back to cited text no. 1
    
2. Singletary SE, Allred C, Ashley P, Bassett LW, Berry D, Bland KI. et al. Revision of American Joint Committee on Cancer Staging System for Breast Cancer. J Clin Oncol 2002;20:3628-36.  Back to cited text no. 2
    
3. Valero V V, Buzdar AU, Hortobagyi GN . The Oncologist 1996;1:8-17.   Back to cited text no. 3
    
4. Klefstrom P, Grohn P, Heinonen E, Holsti L, Holsti P. Adjuvant postoperative radiotherapy, chemotherapy, and immunotherapy in stage III breast cancer. II. 5-year results and influence of levamisole. Cancer 1987;60:936-42.  Back to cited text no. 4
    
5. Toonkel LM, Fix I, Jacobson LH, Bamberg N, Wallach CB. Locally advanced breast carcinoma: results with combined regional therapy. Int J Radiat Oncol Biol Phys 1986;12:1583-7.  Back to cited text no. 5
[PUBMED]    
6. Arnold D, Lesnick G. Survival following mastectomy for stage III breast cancer. Am J Surg 1979;137:362.  Back to cited text no. 6
    
7. Fracchia AA, Evans JF, Eisenberg BL. Stage III carcinoma of breast: A detailed analysis. Ann Surg 1980;192:705-10.  Back to cited text no. 7
    
8. Bruckman JE, Harris JR, Levene MB, Chaffey JT, Hellman S. Results of treating stage III carcinoma of the breast by primary radiation therapy. Cancer 1979;43:985-93.  Back to cited text no. 8
[PUBMED]    
9. Zucali R, Uslenghi C, Kenda R, Bonadonna G. Natural history and survival of inoperable breast cancer treated with radiotherapy and radiotherapy followed by radical mastectomy. Cancer. 1976;37:1422-31.   Back to cited text no. 9
[PUBMED]    
10. Rubens RD, Armitage P, Winter PJ, Tong D, Hayward JL. Prognosis in inoperable stage III carcinoma of the breast. Eur J Cancer 1977;13:805-11.   Back to cited text no. 10
[PUBMED]    
11. Buzdar AU, Singletary SE, Theriault RL, Booser DJ, Valero V, Ibrahim N, et al. Prospective evaluation of paclitaxel versus combination chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide as neoadjuvant therapy in patients with operable breast cancer. J Clin Oncol 1999;17:3412.  Back to cited text no. 11
[PUBMED]  [FULLTEXT]  
12. Smith IC, Heys SD, Hutcheon AW, Miller ID, Payne S, Gilbert FJ, et al. Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel. J Clin Oncol 2002;20:1456.  Back to cited text no. 12
[PUBMED]  [FULLTEXT]  
13. Wenzel C, Bartsch R, Locker GJ, Hussian D, Pluschnig U, Sevelda U, et al. Preoperative chemotherapy with epidoxorubicin, docetaxel and capecitabine plus pegfilgrastim in patients with primary breast cancer. Anticancer Drugs 2005;16:441-5.  Back to cited text no. 13
    
14. Schneerweiss A, Bastert G, Huober J, Wallwiener D, Hamerla R, Lichter P. Neoadjuvant therapy with gemcitabine in breast cancer. Oncology 2004;18:27-31.   Back to cited text no. 14
    
15. DeLena M, Zucali R, Viganotti G, Valagussa P, Bonadonna G . Combined chemotherapy radiotherapy approach in locally advanced breast cancer. Cancer Chemother Pharmacol 1978;1:53-9.  Back to cited text no. 15
    
16. Swain SM, Sorace RA, Bagley CS, Danforth DN Jr, Bader J, Wesley MN, et al. Neoadjuvant chemotharpy in the combined modality approach of locally advanced non metastatic breast cancer. Cancer Res 1987;47:3889-94.  Back to cited text no. 16
[PUBMED]  [FULLTEXT]  
17. Hortobagyi GN, Blumenschein GR, Spanos W, Montague ED, Buzdar AU, Yap HY, et al. Multimodal treatment of locoregionally advanced breast cancer. Cancer 1983;51:763-8.  Back to cited text no. 17
[PUBMED]    
18. Powels TJ, Hickish TF, Makris A, Asley SE, O'Brien SE, Tidy VA, et al. Randomized trial of chemoendocrine therapy started before or after surgery for treatment of primary braest cancer. J Clin Oncol 1995;13:547-52.  Back to cited text no. 18
    
19. Fisher B, Bryant J, Wolmark N, Mamounas E, Brown A, Fisher ER, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 1998;16:2672-85.  Back to cited text no. 19
    
20. Wolmark N, Wang J, Fisher B, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl CancerInst Monogr 2001;30:96-102.   Back to cited text no. 20
    
21. Raina V, Bhutani M, Bedi R, Sharma A, Deo SV, Shukal NK, et al. Clinical features and prognostic factors of early breast cancer at a major cancer center in North India. Indian J Cancer. 2005;42:40-5.  Back to cited text no. 21
    
22. Segal R, Dent SF, Verma S, Gerller S, Young V, Goel R, et al. Changing demographics of locally advanced breast cancer: Data from a regional cancer centre. ASCO 2006.  Back to cited text no. 22
    
23. Erol K, Baltali E, Altundag K, Guler N, Ozisik Y, Onat DA, et al. Neoadjuvant chemotherapy with cyclophosphamide, mitoxantrone, and 5-fluorouracil in locally advanced breast cancer. Onkologie 2005;28:81-5.   Back to cited text no. 23
[PUBMED]  [FULLTEXT]  
24. Deo SVS, Bhutani M, Shukla NK, Raina V, Rath GK and Purkaysth J. Randomized trial comparing neo-adjuvant versus adjuvant chemotherapy in operable locally advanced breast cancer. J Surg Oncol 2003;84:192-7.   Back to cited text no. 24
    
25. Baldini E, Gardin G, Giannessi P G Evangelista G, Roncella M, Prochilo T, et al. Accelerated versus standard cyclophosphamide, epirubicin and 5-fluorouracil or cyclophosphamide, methotrexate and 5-fluorouracil: a randomized phase III trial in locally advanced breast cancer. Ann Oncol 2003;14:227-32.  Back to cited text no. 25
    
26. Raina V, Taneja V, Gulati A. Estrogen receptor status in breast cancer. The Indian Practitioner 2000;53:405-07.  Back to cited text no. 26
    
27. Redkar AA, Kabre SS, Mitra I. Estrogen and progesterone receptors measurement in breast cancer with enzyme-immunoassay and correlation with other prognostic factors. Indian J Med Res 1992;96:1-8.  Back to cited text no. 27
    
28. Hurley J, Doliny P, Reis I, Silva O, Gomez-Fernandez C, Velez P, et al. Docetaxel, cisplatin, and trastuzumab as primary systemic therapy for human epidermal growth factor receptor 2-positive locally advanced breast cancer. J Clin Oncol 2006;24:1831-8.   Back to cited text no. 28
[PUBMED]  [FULLTEXT]  
29. Kuerer HM, Newman LA, Smith TL, Ames FC, Hunt KK, Dhingra K, et al. Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol 1999;17:460-9.  Back to cited text no. 29
    
30. Eltahir A, Heys SD, Hutcheon AW, Sarkar TK, Smith I, Walker LG, et al. Treatment of large and locally advanced Breast Cancer Using Neoadjuvant Chemotherapy. Am J Surg 1998;175:127-32.  Back to cited text no. 30
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]

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