Obesity and response to neoadjuvant chemotherapy in breast cancer

The prevalence of obesity is rising worldwide including Sub-Saharan Africa just as the incidence of breast cancer is rising in same region with increasing morbidity and mortality. Obesity or overweight has been identified as a risk factor for breast cancer and both have been associated with poor outcome of breast cancer treatment. The objective of this study was to assess the effect of obesity /overweight on clinical response to Adriamycin Cyclophosphamide-Paclitaxel (AC-P) regimen neoadjuvant chemotherapy in patients with breast cancer. A prospective observational of 39 female patients with breast cancer. A prospective observational study of newly diagnosed breast cancer patients with palpable breast lumps on neoadjuvant chemotherapy of AC-P regime. Age of the patients, tumour size, stage, estrogen, progestogen and HER2 receptor status were noted. Height measured in metres and weight measured in Kilograms were recorded and Body Mass Index (BMI) calculated .Tumour size measured at presentation, then after first, third, sixth and eighth doses to determine response as defined by the UICC method such as complete clinical response, partial clinical response, stable disease and progressive disease. BMI was then categorized into Normal weight 25kg/m2 and Overweight 25-30kg/m2 and Obese 30kg/m2. 43.6% were obese, 33.3% were overweight and 23.1% were normal weight. Thirty percent of overweight /obese patients had complete clinical response 2 compared with 77% of low/normal weight patients and this was statistically significant (X2 =6.53, p 0.015). 76.7% of the overweight/obese were premenopausal compared with 23.3% who were post menopausal, and this is statistically significant.(X2 =5.84, p 0.024). Obesity/ overweight is associated with poorer clinical response to neoadjuvant chemotherapy in the cohort of patients studied

The effect of neoadjuvant chemotherapy on pathological response and the hormone receptor profile in locally advanced breast carcinomas

Background: The impact of neoadjuvant chemotherapy (NACT) on tumour biomarkers and the histopathological response to treatment in breast cancer specimens remains controversial. Chemotherapy and hormonal therapy decisions for breast cancer management are influenced by the expression of tumour biomarkers: estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth receptor 2 (HER2). On the other hand, pathological response is an indicator of chemotherapy effectiveness. The study of the effect of NACT in breast cancer is an important issue.Objectives: To assess the changes to biological markers ER, PR, and HER2, and the pathological response in locally advanced breast cancer patients after neoadjuvant chemotherapy. Methods: 100 patients with locally advanced breast cancer were assessed with core needle biopsy for biological markers (ER, PR, HER2) and pathological grading. Subsequently they were treated with six cycles of taxane based NACT followed by surgical resection. Biological markers and the pathological response (assessed by the Miller Payne grading system) were re-evaluated to assess changes.Results: The patient mean age was 45.62 ± 7.12 years. Most patients (56%) were postmenopausal. Clinical disease stage ranged between any T N2, T3 N1-2, T4 N0-2. Post NACT, pathological complete response rate was 14%, ER positivity decreased from 80 (80%) to 78 (78%) (p = 0.67). PR positive dropped from 66 to 62% (p = 0.002), and HER2 receptor positivity was increased from 22% to 28% (p-value 0.000).Conclusion: It was observed that biological markers (ER, PR, HER2) and the histopathological response of breast cancer may change after NACT. This change may affect treatment decisions

Complete pathological response in rectal cancer after neoadjuvant therapy - case report

A fifty-four year old woman underwent colonoscopy due to symptoms of altered bowel habit and weight loss. There was a malignant looking lesion at her rectosigmoid junction [Fig. 1a] which was confirmed histologically to be a moderately differentiated adenocarcinoma. Although the blood results were normal, her CT scan and MRI [Fig 2a] showed an apple core lesion at rectosigmoid junction which was deemed to be Stage IIIC (T4aN2aM0)

Evaluation of clinical and pathological response after two cycles of neoadjuvant chemotherapy on Sudanese patients with locally advanced breast cancer

Background:The use of neoadjuvant chemotherapy in treating breast cancer has shown efficacy in downstaging primary tumors; and allows breast conservative surgery to be performed instead of mastectomy. This study aims to evaluate patterns of clinical and pathological response after two cycles of neoadjuvant chemotherapy in patients with locally advanced breast cancer.Materials and Methods:This is a prospective study. Ninety-eight patients who presented from April 2009 through May 2011 with locally advanced breast cancer and treated with neoadjuvant chemotherapy were included.Results:The clinical response rate was 83 ; 11 patients (11.2) had a complete clinical remission (cCR); 71 had a partial remission (72.4); 13 had stable disease (13.3); and 3 had progressive disease (3.1). Seven patients had complete pathological response. Conclusion:Neoadjuvant chemotherapy can achieve a high objective response rate in patients with locally advanced breast cancer even after two cycles. We recommend further research to find predictors for response