| Abstract: |
Introduction
Due to its incidence, Breast cancer remains the most common cancer in women and its leading cause of death in the world. In Algeria, according to the cancer registers already established, we are witnessing a marked increase in the incidence of breast cancer, with more than 6000 new cases each year thus occupying the first place among all cancers of women. Locally advanced forms are predominant in our country (Algeria), they represent more than 75% of cases of breast cancer. Inflammatory breast cancer is a special and rare form. It is essentially characterized by its clinical presentation and its extreme gravity. It represents approximately 1 to 5% of breast cancers with a high frequency in the North Africa countries. In addition, there is a constant rejuvenation of women affected by breast cancer, with a peak frequency before the age of 50. Despite all the therapeutic advances made in the past twenty years, the prognosis of locally advanced and inflammatory forms remains formidable
The aim of this work is to determine, and to find in which therapeutic approach we will have the best response rates and survival rates, a therapeutic approach based on taxanes which will therefore be best indicated in the case of locally advanced breast cancer and inflammatory.
Patients and methods
This is a prospective study on patients with exclusively locally evolved and inflammatory breast cancer, recruited at of the medical oncology service of the university hospital center of Oran over a period of 4 years, going from January 2015 as of December 31, 2018.
The operation has included a group of ninety two patients (92).
Patients selected for the study had locally advanced or inflammatory breast cancer (stage IIb, stage IIIa, stage IIIb)
Primary objective:
To determine the clinical and histological response rates of the Docetaxel-Doxorubicin-Cyclophosphamide combination in locally advanced and inflammatory breast cancer HER negative. Secondary objectives :
Study of epidemiological profiles and diagnostic aspects
-Assessment of the toxicity of the Docetaxel-Doxorubicin-Cyclophosphamide combination.Estimation of the overall survival, without recurrence, of patients subjected to the protocol. Treatment protocol
Chemotherapy is carried out on an outpatient basis at the day's hospital. Patients received the following protocol: Doxorubicin: 50 mg / m2 - Cyclophosphamide: 500 mg / m2 - Docetaxel: 75 mg / m2 Docetaxel is administered after premedication with corticosteroids and growth factors are given routinely
Patient characteristics
characteristics Number (%)
Total number of patients
Age (years)
< 40
40 – 50
> 50
Middle age
Age extremes
Menopausal status
Ovarian activity
Peri menopause
Menopause
Average clinical tumor size
10,1 ± 4,7 mm
Classification
Tumor (T)
T3
T4a
T4b
T4c
T4d
Node (N)
N0
N1
N2
Stage
IIb
IIIa
IIIb
Hormonal status
RE + et /ou PR +
RE – PR –
WHO performance status
WHO 0
WHO 1
Obesity 92
20
34
38
48,3 ± 1,04
28 – 70
44
19
29
-
16
2
12
7
55
21
43
28
9
2
81
59
26
86
6
17 100
21,7
37
40,3
-
47,8
20,7
31,5
-
17,4
2,2
13,0
7,6
59,8
22,8
46,7
30,4
9,8
2,2
88,0
69,5
30,5
93,5
6,5
18.5%
Results :
The rate of objective response is of 86%.
Tumor clinical response rate : Complete clinical response was 65.3% and partial was 34.7%
Lymph node clinical response rate : The complete lymph node clinical response was 64.8% and partial 35.2%. Tumor histological response rate : The complete tumor pathological response was 30.6% and partial 69.4%
Toxicity :
The principal toxicities of rank 3 and 4 allotted to this association of antimitotic are neutropenia (6, 5%), the vomiting (27%), the stomatitis (15%) and the alopecia (93%). No case of allergy was noticed however a moderate asthenia was present at the majority of the patients.
1- Haematological toxicity
Haematological toxicity on J1
Toxicity Grade 1 – 2 Grade 3 – 4
Number % Number %
Leucopenia 11 11,9 1 1,1
Neutropenia 11 12,0 - -
Thrombocytopenia 10 10,9 - -
Anemia 7 7,6 - -
Haematological toxicity on D 10
Grade 1 – 2 Grade 3 – 4
Leukopenia 68 73,9 6 6,5
febrile Neutropenia 12 13,0 4 4,3
Anemia 41 44,5 3 3,3
Thrombocytopenia 24 26,1 2 2,2
2- Non Haematological toxicity
Toxicity Grade 1 – 2 Grade 3 – 4
Number % Number %
Nausea/vomiting 61 66,3 25 27,2
Diarrhea 50 54,3 22 23,9
Stomatitis 57 62,0 14 15
Constipation 13 14,0 - -
Hypersensitivity 16 17,3 - -
Edema 19 44,6 - -
Fluid retention 8 8,7 - -
Alopécia 6 6,5 86 93,5
Nail toxicity 28 30,0 - -
Neuropaty 21 22,8 - -
Skin toxicity 10 10,8 - -
Asthenia 79 85,9 - -
Anorexia 64 69,5 - -
Myalgia 20 21,7 - -
Fever 23 25,0 - -
Overall survival
In our study, the median survival (50%) is 1,550 days (51 months).
At 16 months, the probability of survival of our study series is 98%
At 57 months the probability of survival is 45%.
Conclusion
The neoadjuvant treatment done by the docetaxel - doxorubicine - cyclophosphamide association showed a great effectiveness allowing the operability of the tumors which were from the start inoperable. This was a result of several appreciable objective responses and with an acceptable toxicity level. This whole study leads to an interesting survival rate due to the Taxanes administration.
Key Words:
Inflammatory and advanced breast cancer, Chemotherapy néoadjuvante, Docetaxel – doxorubicine – cyclophosphamide (TAC), Toxicity, Overall survival
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