Neoadjuvant chemotherapy response among patients with locally advanced breast cancer at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia

Abstract

Background

In sub-Saharan African countries including Ethiopia, a high proportion of breast cancer patients present with locally advanced breast cancer (LABC) or metastatic disease at the time of diagnosis. LABC is primarily treated by neoadjuvant chemotherapy (NACT) before surgery. There is, however no data on response rate and resectability of  LABC after NACT in Ethiopia.

Methods

. A total of 141 newly diagnosed patients with histopathological confirmed LABC were evaluated by multidisciplinary team (MDT)  from September 2017 to August 2019, at the Black Lion Hospital. After chemotherapy patients were reevaluated at MDT for modified radical mastectomy. Demographic and clinical data were collected from patient charts and analyzed using SPSS 25 software.

Results

Among 141 breast cancer patients evaluated by breast surgeons and oncologists at a breast multidisciplinary team (MDT) clinic in Tikur Anbessa Hospital, 63 patients were excluded because their tumors were resectable without down staging/NACT. Of these 78 patients with unresectable tumors, 27 patients were excluded from the study because they received <4 cycles of NACT or were lost to follow-up, leaving 51 patients for the final analysis. Among the 51 patients with LABC who received NACT, eleven patients (21.6 %) had complete clinical response (cCR) and 31 patients (60.8 %) had partial clinical response (cPR). Forty-one patients (80.4 %) underwent mastectomy, and margin status was negative in 23 patients (56.1 %). Only 4 patients (9.8 %) had complete pathologic response (pCR) after NACT. Patients who received AC – T (NACT) had slightly significant overall clinical response rate (p = 0.099) and cCR (p = 0.037) compared to patients who received AC NACT.

Conclusion

Neoadjuvant chemotherapy for patients with LABC in Ethiopia setting has significantly reduced tumor size in most patients, allowing modified radical mastectomy.