Response to neoadjuvant chemotherapy in patients with advanced breast cancer: a local hospital experience

A large proportion of women present with advanced breast cancer in the developing countries with limited resources. Many of these patients have ulcerated, bleeding lesions or visually obvious masses in the breast. Neoadjuvant chemotherapy is well established as the standard of care and initial management of choice for these patients. Tumor shrinkage achieved with neoadjuvant chemotherapy has the advantage of converting an inoperable disease to an operable condition, with the option of breast conservation surgery where mastectomy is the only initial option for loco-regional control. Neoadjuvant chemotherapy also provides the earliest possible treatment of micrometastases and thus improves survival. In the present study, 165 advanced breast cancer female patients registered at the Institute of Nuclear Medicine and Oncology, Lahore, Pakistan, between 1st July 2005 and 30th June 2007 were evaluated for response to neoadjuvant chemotherapy. Tumor measurements were made and recorded prior to the first cycle of chemotherapy and 3 weeks after the third cycle. A clinical complete response was seen in 7.3%, a partial response in 60%, stable disease in 24% and progressive disease in 9%. A complete pathological response was only seen in 3.6% of evaluable patients. We conclude that breast cancer in patients presenting for neoadjuvant chemotherapy at our facility is more aggressive, generally presents as more advanced and bulky local disease, affects a younger population and features a low and unpredictable response to neoadjuvant chemotherapy.