Neoadjuvant Chemotherapy in Breast Cancer: How Many Courses are Adequate?

Abstract

Background: Neoadjuvant chemotherapy (NAC) has been found very useful in the treatment of locally advanced breast cancer. The  number of chemotherapy cycles given during NAC varied between 4-6 cycles in most studies.

Objectives: To assess the number of  courses of NAC that will show the earliest and most significant reduction in sizes of breast mass.

Methodology: The size of breast masses  and regional lymph nodes in the pre-menopausal women were assessed before each course of chemotherapy and three weeks  after the 4th course of NAC. A Doxorubicin containing regimen: cyclophosphamide, doxorubicin and 5- fluorouracil (CAF) was given at 3  weekly intervals. Medication response was evaluated using a modification of the RECIST (Response Evaluation Criteria In Solid Tumours)  methodology. The data were analyzed using the SPSS statistical software version 23.0. (Statistical Package for Social Sciences SPSS Inc.).  

Results: Forty-nine patients completed the four courses of neoadjuvant chemotherapy with age range of 24-54years and mean age of  40.92±7.98 years. The initial sizes of the breast masses ranged from 3.0-25.0cm with mean of 9.70±4.33cm. The mean size of the breast  masses after 1st, 2nd, 3rd and 4th course were: 8.26±4.13cm, 6.72±4.32cm, 6.09±4.97cm and 5.79±5.35cm respectively. The size reduction  were very significant, Spearman's correlation coefficients rs values of 0.869, 0.667, 0.619 and 0.599 from 1st to 4th course. The patients  achieved clinical complete response (cCR) of 0%, 2.0%, 10.2% and 18.4% after the 1st to 4th courses.

Conclusion: The tumour sizes in  premenopausal breast cancer showed significant reduction after the first to the fourth courses of neoadjuvant chemotherapy.  Chemotherapy regimen should be reviewed after the third course if there is no significant clinical response.