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Trends in systemic management (SM) for the treatment of locally advanced breast cancer: Data from a regional cancer centre.

10728 Background: Locally advanced breast cancer (LABC) accounts for less than 5% of women diagnosed with breast cancer in North America each year. The scarcity of clinical trials addressing the SM of these women continues to represent a challenge for clinicians.


METHODS
A retrospective database was developed using the American Joint Committee on Cancer (AJCC) 2002 staging classification for all women who presented to TOHRCC with LABC between Jan 1/02-April 1/05. Information was obtained from clinic charts and patient self-reported questionnaires.


RESULTS
Outcomes reflect the SM of the first 50 women entered into our database. Median age at presentation was 57 years (range 28-88); 62% were post-menopausal; and hormonal status was 52% estrogen receptor (ER) positive and 54% progesterone receptor (PR) positive. Surgery was performed prior to chemotherapy in 50% of patients (pts).The majority (90%) of pts received SM as follows: 38% anthracyclines (A) alone (52% epirubicin, 26% adriamycin, 2% both); 7% taxanes (T) alone (33% paclitaxel, 66% docetaxel), 53% received both T and A regimens, and 2% received other types of chemotherapy (gemcitabine,vinorelbine,capecitabine). The addition of trastuzumab to the SM of HER2-positive pts has also been observed. Hormone therapy was given to 22 pts (44%) of whom 82% were ER or PR-positive: tamoxifen (27%); aromatase inhibitors (AIs; 50%); both tamoxifen and AIs (23%). Pts were treated with AIs as follows: anastrozole (73%); fulvestrant (9%), and atemestane (9%). In pts with measurable disease receiving neoadjuvant SM; 7(35%) had a complete clinical response and 13 (65%) had a partial response; mean tumour size decreased from 7.5 cm (range 2-22) to 2.8 cm (range 0-8). Pathological complete response rates and improved survival rates have been observed and will be reported in detail.


CONCLUSIONS
These results represent our first analysis of treatment outcomes in women with LABC using the new AJCC system. This database highlights the increased utilization of T and AIs in the SM of these pts, which seems to translate into the increasingly observed improvements in overall survival. Microarray studies to further explore predictability of treatment outcomes are planned. No significant financial relationships to disclose.