Neoadyuvant chemotherapy in patients with breast cáncer locally advanced, treated with doxorubicin and cyclophosphamide and taxanes with or without trastuzumab.
Quimioterapia neoadyuvante en pacientes con cáncer de mama localmente avanzado, basada en el esquema ciclofosfamida, doxorrubicina, taxanos con y sin trastuzumab, de acuerdo con la sobreexpresión de HER2.
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Background: The actual use of neoadjuvant chemotherapy in breast cancer locally advanced is an indication, that raises the chance to reduce the size of the tumor and perform conservative surgery. Objetive: Describe the response to chemotherapy AC (doxorubicin and cyclophosphamide) and taxanes with or without trastuzumab usually administered in the neoadjuvant therapy. Methods: The study is a observational descriptive prospective, made between october 2012 and may 2014, including women older than 18 years selected by convenience, with diagnosis by histopathology of infiltrating epithelial breast cancer with clinical stage IIB, IIIA, IIIB and IIIC according to the classification of AJCC, with functional status less or equal to 2 and negative extension studies to metastatic disease no more than two months. Results: The total sample was of 109 women, the average age was 53.3 years, the median tumor size was about 5 cm 85.4% of the women complete the whole treatment. The frequency of the intrinsic groups goes as it follows, luminal B1 (41.2%), luminal A (17.5%), triple negative (17.5%), luminal B2 (16.5%) and HER2 (7.2%). 31 conservative surgeries were performed. The global pathological complete response was of 19.7%. The biggest pathological response was in the triple negative subgroup 33.3% and in patient with overexpression of HER2 the response was 38.9%; luminal A response was quite low 5.6%. Conclusion: The neoadjuvant sequential chemotherapy based on AC protocol follow up by taxanes associated or not to trastuzumab according to the over-expression of HER2, improves pathologic complete response, and rise the number of conservative surgeries with minimal toxicity in the patients with breast cancer locally advanced in the Instituto Nacional de Cancerología, with similar results compared to the international literature.
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Bray F, Ferlay J, Soerjomataram I, et at. Global cancer statistics 2018: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68:394-424.
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Annals of Surgical Oncology. 2010:1471-4.
Boughey JC, Peintinger F, Meric-Bernstam F, Perry AC, Hunt KK, Babiera G V, et al. Impact of preoperative versus postoperative chemotherapy on the extent and number of surgical procedures in patients treated in randomized clinical trials for breast cancer. Ann Surg. 2006;244 (3):464-70.
Cancerología IN de. Primary systemic therapy of breast cancer. The Oncologist. Bogotá, United States; 2011. 31-84 p.
Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: The CTNeoBC pooled analysis. Lancet. 2014;384 (9938):164-72.
Instituto Nacional de Cancerología. Anuario estadístico 2012. Bogotá; 2012. 110 p.
Sánchez J. Experiencia clínica del uso de quimioterapia neoadyuvante con esquema AC en pacientes con cáncer de mama. Rev Colomb Cancerol. 2014;18 (4):211-2.
Buzdar AU, Ibrahim NK, Francis D, Booser DJ, Thomas ES, Theriault RL, et al. Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol. 2005;23(16):3676-85.
Bear HD, Anderson S, Smith RE, Geyer CEJ, Mamounas EP, Fisher B, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2006;24(13):2019-27.
Stephen Edge. AJCC Cancer Staging Manual. 7th ed. Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. Springer-Verlag New York; 2010. 648 p.
Ministerio de Salud y Protección Social, Colciencias, Instituto Nacional de Cancerología, ESE-Fedesalud. Guía de atención integral para la detección temprana, tratamiento integral, seguimiento y rehabilitación del cáncer de mama. Bogotá; 2013. 929 p.
Gradishar WJ, Anderson BO, Blair SL, Burstein HJ, Cyr A, Elias AD, et al. Breast cancer version 3.2014. J Natl Compr Canc Netw. 2014;12(4):542-90.
Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA [Internet]. 2001;98(19):10869-74. Disponible en: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=58566&tool=pmcentrez&rendertype=abstract
Perou CM, Sørlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees Ca, et al. Molecular portraits of human breast tumours. Nature. 2000;406(6797):747-52.
Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn H-J. Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Annals of Oncology: official journal of the European Society for Medical Oncology. 2011:1736-47.
Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events, Version 3.0 [Internet]. 3rd ed. 2006.
p. Disponible en: http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf
Hunter RD. WHO handbook for reporting results of cáncer treatment [internet]. International Journal of Radiation Biology. 1980. p. 45 p. Disponible en: http://informahealthcare.com/doi/abs/10.1080/09553008014551861
Cortazar P, Geyer CEJ. Pathological complete response in neoadjuvant treatment of breast cancer. Ann Surg Oncol. 2015; 22(5):1441-6.
von Minckwitz G, Kummel S, Vogel P, Hanusch C, Eidtmann H, Hilfrich J, et al. Neoadjuvant vinorelbine-capecitabine versus docetaxel-doxorubicin-cyclophosphamide in early nonresponsi ve breast cancer: phase III randomized GeparTrio trial. J Natl Cancer Inst. 2008;100(8):542-51.
Schwartz GF, Hortobagyi GN. Proceedings of the consensus conference on neoadjuvant chemotherapy in carcinoma of the breast, april 26-28, 2003, Philadelphia, Pennsylvania. Cancer. 2004;100(12):2512-32.
Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. 2001;(30):96-102.
Gianni L, Eiermann W, Semiglazov V, Lluch A, Tjulandin S, Zambetti M, et al. Neoadjuvant and adjuvant trastuzumab in patients with HER2-positive locally advanced breast cáncer (NOAH): follow-up of a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet Oncol. England; 2014;15(6):640-7.
Untch M, Rezai M, Loibl S, Fasching PA, Huober J, Tesch H, et al. Neoadjuvant treatment with trastuzumab in HER2-positive breast cancer: results from the GeparQuattro study. J Clin Oncol. 2010;28 (12):2024-31.
Rastogi P, Anderson SJ, Bear HD, Geyer CE, Kahlenberg MS, Robidoux A, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008;26(5):778-85.
Baselga J, Bradbury I, Eidtmann H, Di Cosimo S, de Azambuja E, Aura C, et al. Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomised, open-label, multicentre, phase 3 trial. Lancet. 2012;379(9816):633-40.
