Sivasanker Masillamany, Sistla S C, Manwar S Ali, Vivekanandam S
Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Department of Radiotherapy, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Indian J Cancer. 2016 Apr-Jun;53(2):220-225. doi: 10.4103/0019-509X.197715.
Neoadjuvant chemotherapy has become the standard recommendation in the management of patients with locally advanced breast cancer. At present anthracycline based regimen such as CAF (cyclophosphamide, adriamycin and 5-FU) is widely used in clinical practice. The introduction of taxanes has revolutionized this field because of superior results.
This study is designed to compare the efficacy of paclitaxel plus doxorubicin regimen and CAF (cyclophosphamide, doxorubicin and 5-fluorouracil) regimen as neoadjuvant treatment of locally advanced breast cancer and to compare their toxicity profiles and also to correlate the hormonal receptor status in predicting response to the NACT.
In this prospective study, 101 patients with newly diagnosed locally advanced breast cancer were randomized to receive either CAF or Paclitaxel/adriamycin as NACT for three cycles. The response was assessed objectively using CT scans and applying RECIST criteria. The patients were monitored for hematologic, cardiac and other minor toxicities.
There was a significantly increased complete and objective response seen in the AP group when compared to CAF group (24% and 58% in the AP group versus 7.8% and 39.2% in the CAF group, P value 0.0313 for complete response). The pCR rate was also significantly higher in the AP group compared to CAF group. (20.93% versus 4.34%, P value 0.0237). There was no significant difference between the groups with respect to cardiotoxicity and hematotoxicity. Patients with ER negative tumors have responded well to neoadjuvant chemotherapy better than ER positive patients. (Objective response 62.8% vs. 40%, P - 0.0473).
Based on these results, taxane based regimen such as Paclitaxel/adriamycin can be recommended as a first line neoadjuvant regimen in patients with locally advanced breast cancer.
新辅助化疗已成为局部晚期乳腺癌患者治疗的标准推荐。目前，以蒽环类药物为基础的方案，如CAF（环磷酰胺、阿霉素和5-氟尿嘧啶）在临床实践中被广泛应用。紫杉烷类药物的引入彻底改变了这一领域，因为其效果更佳。
本研究旨在比较紫杉醇联合阿霉素方案与CAF（环磷酰胺、阿霉素和5-氟尿嘧啶）方案作为局部晚期乳腺癌新辅助治疗的疗效，比较它们的毒性特征，并关联激素受体状态以预测对新辅助化疗的反应。
在这项前瞻性研究中，101例新诊断的局部晚期乳腺癌患者被随机分为两组，分别接受CAF或紫杉醇/阿霉素作为新辅助化疗，共三个周期。使用CT扫描并应用RECIST标准客观评估反应。对患者进行血液学、心脏和其他轻微毒性监测。
与CAF组相比，AP组的完全缓解和客观缓解率显著提高（AP组分别为24%和58%，CAF组分别为7.8%和39.2%，完全缓解的P值为0.0313）。AP组的pCR率也显著高于CAF组（20.93%对4.34%，P值0.0237）。两组在心脏毒性和血液毒性方面无显著差异。雌激素受体阴性肿瘤患者对新辅助化疗的反应优于雌激素受体阳性患者（客观缓解率62.8%对40%，P = 0.0473）。
基于这些结果，对于局部晚期乳腺癌患者，可推荐以紫杉烷类药物为基础的方案，如紫杉醇/阿霉素作为一线新辅助方案。
