Clinical, Molecular Profiles and Response to Neoadjuvant Chemotherapy in Patients with Locally Advanced Breast Cancer: An Indian Experience

ABSTRACT Background Breast cancer is now the most common cancer in many parts of India and Locally advanced breast cancer (LABC) accounts for nearly one thirds of cases. Advanced stages at presentation are attributed to late diagnosis and biologically aggressive disease in Indian women. Materials and methods Patients diagnosed with inoperable LABC at the Gujarat Cancer and Research Institute, Ahmedabad, India were included in the study. Baseline evaluation included clinical assessment, testing for Estrogen Receptor(ER), Progesterone Receptor (PgR), Her2Neu and serum Vascular Endothelial Growth Factor (S. VEGF). First line NACT was FAC or FEC. Patients were assessed clinically and radiologically at the end of 3 cycles for response evaluation (mammography or ultrasonography of breast). S. VEGF levels were repeated at the end of 3 cycles of NACT or before surgery. All resectable patients underwent a Modified Radical Mastectomy. Unresectable patients were offered taxanes based chemotherapy or supportive care. Results Fifty seven patients with LABC were included. Fifty Four patients (95%) received NACT. Mean age at diagnosis was 49 years. ER was positive in 51%, PgR in 35% and Her2Neu in 47%. Mean baseline S. VEGF was 463.4pg/ml. Baseline S. VEGF was higher in patients who were hormone receptor or Her2Neu positive. The overall clinical response rate [complete response (cCR) + partial response (cPR)] to the initial anthracycline based chemotherapy was 63%, cCR was 0%. Resectability rate after 1st line NACT was 77%. Pathological CR (pCR) rate was 4%. There was no significant reduction in S. VEGF levels after NACT, irrespective of clinical or pathological responses. Nearly 17% of patients were lost to follow up at various stages of treatment including three patients who refused any kind of treatment. Conclusions This study analyzes clinical and molecular profile of patients with LABC in India which differs from that seen in developed nations. High treatment drop-out rates may reflect treatment related toxicities, socio-cultural and logistical issues in a big developing country. Responses to anthracycline based NACT are comparable to the results reported from similar centers. Disclosure All authors have declared no conflicts of interest.