Localised breast cancer: neoadjuvant chemotherapy impact evaluation on the pathological complete response (PCR) in a lower middle-income country

Ganiou Adjadé; Hassan Abdelilah Tafenzi; Houda Jouihri; Nadin Shawar Al Tamimi; Yousra Bennouna; Gustave Négamiyimana; Kalil Cisse; Ismail Essadi; Mohammed El Fadli; Rhizlane Belbaraka

doi:10.3332/ecancer.2023.1648

Localised breast cancer: neoadjuvant chemotherapy impact evaluation on the pathological complete response (PCR) in a lower middle-income country

Ecancermedicalscience. 2023 Dec 15:17:1648. doi: 10.3332/ecancer.2023.1648. eCollection 2023.

Authors

Affiliations

¹ Department of Medical Oncology, Mohammed VI University Hospital, 2360 Marrakech-principal, Morocco.
² https://orcid.org/0000-0003-0768-7493.
³ Biosciences and Laboratory, Faculty of Medicine and Pharmacy, Cady Ayyad University, 7010, Sidi Abbad, Marrakech 40000, Morocco.
⁴ Department of Medical Oncology, Avicenna Military Hospital, Marrakech 40000, Morocco.

Abstract

Introduction: Neoadjuvant chemotherapy followed by surgery remains the current recommended therapeutic strategy for the management of locally advanced breast cancer. The standard chemotherapy protocol is sequential with anthracycline followed by taxanes. However public hospitals in Morocco are confronted with a shortage in healthcare products. We, therefore, evaluated the efficacy of the different protocols proposed to patients, by evaluating the clinical response after chemotherapy especially through the pathological complete response (PCR) after surgery.

Methods: We focused on the database of the medical oncology department of the only public hospital covering middle and southern Morocco. We included patients diagnosed between 2018 and 2020. Two groups of patients distinguished in group A (GA) received the standard therapy, and group B (GB) received a non-standard protocol. The therapeutic response was assessed clinically before surgery and then by pathological examination of the surgical specimens. The Sataloff classification defined the histological response for both tumour and lymph nodes. We included both groups in one variable to determine their impact on outcomes. A logistic regression-based analysis was adopted to define variables related to the PCR.

Results: Over the study period, 120 patients met our inclusion criteria. They were distinguished at 72% in GA and 28% in GB. 60.8% over 120 got a partial response, whereas, only 33.3% achieved a complete response. The general PCR rate was 28% with 14.3% in GB and 85.7% in GA. The tumour PCR was obtained in 40 (33.3%) over 120 patients and 51.7% of lymph node PCR. The multivariate logistic regression analysis results show no relative factors associated with general PCR achievement.

Conclusion: These first interesting results from an institutional database inform us about our clinical practice and require additional research using prospective randomised controlled studies.

Keywords: Morocco; PCR; breast cancer; chemotherapy; localised; neoadjuvant.