Neoadjuvant chemotherapy

Neoadjuvant chemotherapy (NAC) has been a common approach for the management and treatment of locally advanced breast cancer (LABC). It is applied very effectively for treatment of patients with LABC before breast and axillary lymph node resection (Pusztai, 2008). The NAC is aimed to reduce tumor size subsequently aiding mastectomy and radiotherapy (Cleator et al., 2002; and Pusztai, 2008). NAC is better treatment option because it averts adverse physiological reactions (Alvarado-Cabrero et al., 2009).

Patients of LABC had showed complete clinical and pathological response to NAC, while those with pure micropapillary carcinoma (PMC) gave incomplete response (Alvarado-Cabrero et al., 2009). Patient's therapy effect can be predicted by clinical & pathological responses (Jones et al., 2006), and by biomarker levels in the patients, which have better prognostic influence in contrast to pathological and clinical response, multi-biomarker levels have showed better expressive power for treatment outcome as compared with single biomarker level (Nolen et al., 2008).

Paclitaxel is a chemical agent applied before radiotherapy and surgery. It binds to tubulin resulting in cell cycle arrest at M-phase which enhances radiation sensitivity. In a report, Patients having 3 cycles of paclitaxel followed by simultaneous radiotherapy before specific surgery, showed better results as compared those without paclitaxel (Chakravarthy et al., 2000). The most common approach for treating LABC in developed countries consists of NAC with anthracyclines and taxanes followed by surgery and radiation therapy (Osako et al., 2007). HR-positive tumors are less chemosensitive so an anthracyline based NAC is developed without hormonal treatment to evaluate estrogen receptor (ER) and progesterone receptor (PgR) semi-quantitative expression in patients with HR-positive tumors (Petit et al.,

2010). Preoperative and postoperative marker studies in NAC might facilitate tumor analysis and to observe possible change in status respectively (Piper et al., 2004).

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