Neoadjuvant chemotherapy for locally advanced premenopausal breast cancer in Nigerian women: early experience

Breast cancer, the commonest female malignancy in Nigeria presents late, with bulky locoregional masses and predominantly in a pre and peri-menopausal setting. Treatment when feasible has been with mutilative surgery with a poor patient acceptance rate. Chemotherapy which is widely used in adjuvant and metastatic settings has recently been indicated in the neo-adjuvant setting.

Locally-advanced female breast cancer patients [AJCC Stages IIIA, IIIB, IIIC], seen in the breast clinic from July, 2006 to March 2007 were recruited into the study after informed consent. Patients received doxorubicin, 5-fluoro-uracil and cyclophsphamide by intravenous bolus or infusional injection on a three weekly regimen as day cases. The dominant lesion was assessed by calipers at each visit. Therapeutic clinical responses were assessed as none; partial, complete.

During the period 32 women (33 breast cancers) were seen and recruited. The numbers steadily declined over time and only 28 completed the treatment modality. Mean pre-chemotherapy tumour size was 13.5cm which declined to 7 cm at the 5th. One patient (3.6%) exhibited complete clinical response, 25 (89%), partial response and 2 had no response. No serious toxicities were noted.

Neo-adjuvant chemotherapy using anthracycline based regimens is efficacious and safe in reducing tumour bulk in locally advanced breast cancers. The use should be encouraged to make bulky tumours operable.