Neoadjuvant docetaxel and epirubicin in large and locally advanced breast cancer: kuwait cancer control centre experience.

Purpose: To evaluate the efficacy of neoadjuvant (NA) docetaxel (DOC) and Epirubicin (EPI) as a part of multimodality treatment of large and locally advanced breast cancer. Patients and Methods: Patients with large or locally advanced breast cancer received four cycles of DOC 75mg/m2 and Epirubicine (EPI) 90mg/m2 (DE). Clinical tumor response was assessed. Patients with operable disease were subjected to modified radical mastectomy (MRM) or breast conserving surgery (BCT) and axillary lymph node dissection (ALND). All patients received four cycles of DOC 100mg/m2 as post operative chemotherapy and local radiotherapy. Tamoxifen was given to patients with hormone receptor positive tumors. Results: A total of 80 patients were enrolled; 75 patients completed at least 3 cycles of NA CT and were evaluable. Out of these 75 patients, 67 (89.3%) patients completed all 4 cycles of DE, while 8 (10.7%) patients received 3 cycles of DE. Out of all 75 patients; 25 patients (33.3%) achieved clinical complete response (cCR), while 41 patients (54.7%) achieved clinical partial response (cPR), making a total of 66 patients (88.0%) who achieved a clinical response (cPR or cCR). Five patients (6.7%) had stable disease (cSD), while two patients (2.7%) had progression of disease (cPD). A total of 69 patients underwent surgery, out of those, 65 patients (94.2%) underwent MRM and 4 patients (5.8%) had BCT and ALND. Out of 69 patients evaluated for pathological response, 7 patients (10.1%) had pathologic CR (pCR) and 62 (89.9%) patients had pathological PR (pPR). Axillary lymph node examination revealed no residual tumor in 23 (33.3%) patients. Grade IV neutropenia occurred in 92 (30.9%) cycles while febrile neutropenia occurred in 17 (5.7%) cycles. Conclusion: NA DE is an effective regimen with an acceptable toxicity profile.