ER,PR And C-erbB-2 Expression In Locally Advanced Breast Cancer Change After Neoadjuvant Chemotherapy And Its Prediction To Response Of Neoadjuvant Chemotherapy.

Purpose: To evaluate the clinical and pathologic response and toxicity ofdocetaxel(DOC) and epirubicin(E) and cyclophosphamide(C) as the neoadjuvantchemotherapy in the treatment of locally advanced breast cancer(LABC). To identifypredictive markers that may effectively predict the clinical and pathologic response of theneoadjuvant chemotherapy. To have a preliminary investigation of the relationshipbetween the changing of biomarkers expression induced by neoadjuvant chemotherapyand response of the neoadjuvant chemotherapy.Patients and Methods: From March 2005 to October 2006, 46 patients with LABCwere treated with TAC chemotherapy before operation. Neoadjuvant chemotherapycontaining epirubicin(E), 60 mg/m2 (days 1) cyclophosphamide(C),500 mg/m2 (days 1)and docetaxel(DOC), 75 mg/m2 (days 2) was administered every 3 weeks for threecycles before local treatment,, epirubicin(E),75 mg/m2 (days 1 and 2)cyclophosphamide(C),500 mg/m2 (days 1) and docetaxel(DOC), 85 mg/m2 (days 3)was administered for two cases of bilateral breast cancer as before. Core needle biopsysamples were obtained before the initiation of neoadjuvant chemotherapy. Biologicalmarkers ER,PR,c-erbB-2 were evaluated by IHC in the preneoadjuvant chemotherapybiopsy specimens and postoperative tumor tissue. The relationship between the response and the expression of biomarkers in the preneoadjuvant chemotherapy core specimensand characteristic of patients were analyzed to find the predictive factors of neoadjuvantchemotherapy. Comparisons of expression of biomarkers before and after neoadjuvantchemotherapy in responding and non-responding group in order to have a investigation ofbiological mechanism of neoadjuvant chemotherapy.Results: The clinical objective response was 80.4% (37/46), 15.2%(7/46) cCR and57.8%(30/46) cPR). Pathological complete response was found in 4 cases (8.3%). Themost common toxicities are neutropenia, alopecia and nausea/vomiting, one casepulmonary embolism, but there was no serious septemia and toxic deaths. Changes in allthe biomarkers after neoadjuvant chemotherapy were observed. ER and PR negativetumor more likely to be changed into positive expression after neoadjuvant chemotherapythan that of positive changed into negative (ER: 22.92% vs. 18.83%; PR: 20.83% vs.14.58% P＞0.05).Conclusion: The combination of docetaxel,epirubicin and cyclophosphamide is avery active and well-tolerated regimen as neoadjuvant chemotherapy for the LABC. Theneoadjuvant chemotherapy can modulate the expression of tumor biomarkers. The studydoes not finds the relationship between the changing of ER,PR and c-erbB-2 expressioninduced by neoadjuvant chemotherapy and response of the neoadjuvant chemotherapy.