The Clinical Study Of NP Followed TAC In Neoadjuvant Chemotherapy

Objective:The neoadjuvant chemotherapy is applied to clinic more and more for locally advanced breast cancer.There are many merits of it,for example,downing the stage of the breast cancer,increasing the resection rate,reducing distant metastasis, the best drug sensitive test in vivo. There are no standard chemotherapy regimes at the moment. In the abroad clinical research they adopt antracyclines and taxanes as the first line chemotherapy regimen. But not all the tumor is sensitive to this regimen as a result of the tumor heterogeneity.then it is very important to select an effective regimen. Literature at home and abroad reported that the most effective drug are vinorelbine、capecitabine、gemcitabine、ixabepilone and platinum. The research also reported that platinum was sensitive to breast cancer patients who carried BRCA1gene mutation,most of whom were TNBC,The first aim of the study is to discuss the effect of vinorelbine-cisplatin in anthracycline and taxane-resistant local advanced breast cancer in neoadjuvant chemotherapy. The second aim of the study is to discuss the special effective of vinorelbine-cisplatin to TNBC.Methods:Thirty and eight patients who were resistanced to antracyclines and taxanes at first and transform to NP regimen in the follow neoadjuvan chemotherapy were included in this retrospective study. TNBC is defined as the lack of estrogen receptor(ER), progesterone receptor(PR), and human epidermal growth factor receptor2(Her-2)expression by immunohistochemistry method. the others were defined as non-TNBC, the relationships of response and survival between TNBC and non-TNBC who accept NP regimen were analyzed.Results:Of the38patients,12(31.6%)were TNBC and26(68.4%)were non-TNBC. The overall response rate(OR)was76.3%(29/38), The pathologic complete response(pCR)was18.4%. The pCR in patients with TNBC were significantly higher than patients with non-TNBC respectively(41.7%and7.7%)(P<0.05). Patients with TNBC had worse5-year disease free survival(DFS)than those with non-TNBC (P<0.05). The5-year overall survival(OS)was50.0%for TNBC and80.2%for non-TNBC. If pCR were achieved, patients with TNBC or with non-TNBC had similar5-year DFS and5-year OS(P>0.05). In contrast, TNBC patients with residual disease after neoadjuvant chemotherapy had worse5-year DFS and OS compared with non-TNBC(P<0.05)Conclusion:Patients with TNBC were more sensitive to NP regimen neoadiuvant chemotherapy than those with non-TNBC. Patients with TNBC have increased pCR rates compared with non-TNBC, and those with pCR had a good prognosis. TNBC patients in whom pCR were not achieved have significantly worse survival compared with non-TNBC.