Neoadjuvant chemotherapy for Chinese women with locally advanced breast cancer

Locally advanced breast cancer carries a poor prognosis and is still prevalent in developing countries. The current management usually involves administration of neoadjuvant chemotherapy (NCT). From March 1990 through December 1997, 173 Chinese patients with tumor size greater than 4 cm were treated; 38 received NCT and the other 135 postoperative adjuvant chemotherapy. The regimens for NCT were FEC (5-fluorouracil 600 mg/m2, epirubicin 50 mg/m2, and cyclophosphamide 600 mg/m2) for 29 patients and Adriamycin 75 mg/m2 for the rest of the group. Postoperatively the NCT patients received the standard CMF regimen (oral cyclophosphamide 100 mg/m2 for 14 days and intravenous methotrexate 40 mg/m2 and 5-fluorouracil 600 mg/m2 on days one and eight of each cycle). The postoperative adjuvant chemotherapy group received only the CMF regimen. Tumor response after NCT was measured clinically and histologically. The response rate was 75 per cent with 13.2 per cent being complete response. Although there is no difference in response rate the actual reduction in size was greater for patients receiving Adriamycin than FEC (P = 0.001). The only predictive factor of response to NCT was the type of chemotherapy administered. None of the tumor characteristics such as size, nodal status, histological grading, lymphovascular permeation, hormonal receptor status, and c-erb-B2 expression were found to be significant. The overall 5-year probability of survival was 0.44, and there was no difference between groups. The factor important for prognosis was axillary nodal status on histology. The use of NCT did not improve outcome. In summary our results showed that NCT was feasible for Chinese women and good response could be achieved. However, it is the axillary nodal status that determines the final outcome.