ABSTRACT
BACKGROUND/AIM: To substitute paclitaxel in neoadjuvant chemotherapy of breast cancer by nab-paclitaxel due to its improved efficacy and safety profile. PATIENTS AND METHODS: Sixteen patients with primary breast cancer received neoadjuvant chemotherapy with 4 cycles of nab-paclitaxel at 150 mg/m(2) (d1, 8, 15, every 28 days followed by 4 cycles of epirubicin at 90 mg/m(2) d1, every 21 days and cyclophophosphamide at 600 mg/m(2) (d1, every 21 days plus, if human epidermal growth factor receptor 2 (HER2)-positive, trastuzumab, and in 2 cases trastuzumab and lapatinib. End-points were the rate of pathological complete response (pCR) and safety. RESULTS: All patients responded after two cycles. Overall, 11/16 patients had pathological complete response: 5/6 with HER2-positive, 3/4 with triple-negative and 3/6 with HER2-negative, hormone receptor-positive disease. Adverse events of grade 3 or more occurred in 4 patients. There were no grade 4 or 5 toxicities. The most frequent side-effects (all grades) were peripheral polyneuropathy (n=11, n=4 grade 2), fatigue (n=9) and hand-foot syndrome (n=8). Overall, side-effects were easily managed. CONCLUSION: Neoadjuvant chemotherapy with nab-paclitaxel is a good alternative to paclitaxel-based regimens.
Subject(s)
Albumins/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Neoadjuvant Therapy , Paclitaxel/therapeutic use , Adult , Aged , Albumins/administration & dosage , Albumins/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Cyclophosphamide/administration & dosage , Drug Administration Schedule , Epirubicin/administration & dosage , Female , Humans , Middle Aged , Neoadjuvant Therapy/adverse effects , Neoplasm Staging , Paclitaxel/administration & dosage , Paclitaxel/adverse effects , Treatment OutcomeABSTRACT
Overexpression of CD24 is an independent prognostic factor for breast cancer. Recently, two polymorphisms in the CD24 gene were linked to disease risk and progression in autoimmune diseases. Here, we evaluated the clinical relevance of these polymorphisms with respect to their potential to predict a pathologic complete response (pCR) to neoadjuvant chemotherapy (NCT) for primary breast cancer (PBC), one of the strongest prognostic factors in this setting. A total of 257 patients were randomized to either doxorubicin/cyclophosphamide (AC) or doxorubicin/pemetrexed (AP), both followed by docetaxel (Doc) as NCT for T2-4 N0-2 M0 PBC as part of an international, multicenter, randomized phase II trial. CD24 polymorphisms were analyzed on germ line DNA and correlated with clinicopathologic variables and pCR. No significant associations were found between either of the polymorphisms and any of the clinicopathologic variables. In a multivariate analysis, CD24 Val/Val genotype was the only significant predictor of pCR (OR: 4.97; P = 0.003). The predictive potential was significant in both treatment arms and in the hormone receptor-positive subgroup. There was no correlation between CD24 3'UTR (TG/Del) genotype and pCR. We did not observe any association between CD24 genotype and CD24 protein expression or in vitro chemosensitivity, but there was a significant correlation between CD24 Val/Val and intratumoral lymphocyte aggregates. In conclusion, CD24 Ala/Val SNP is a strong and independent predictor of pCR after NCT for PBC and may affect immune functions rather than tumor characteristics. Further evaluation of the CD24 function and validation of its predictive potential are clearly warranted.