The Impact of Neoadjuvant Chemotherapy on Breast Cancer

Background: Breast cancer (BC) is a heterogeneous disease that requires multimodal treatment. Adoption of neoadjuvant chemotherapy (NACT) as a standard approach for patients with high-risk early-stage or locally advanced breast cancer represents a significant development in breast cancer management. Objective: This study aimed to evaluate the outcomes of NACT on BC, specifically regarding overall response rate (ORR), breast conservation eligibility rate, overall survival (OS) rate, disease-free survival (DFS) rate, and factors that may influence these outcomes. Patients and method: A retrospective study of 200 patients with locally advanced or high-risk early-stage breast cancer who attended Clinical Oncology and Nuclear Department at Mansoura University Hospitals between January 2018 and December 2021 who were treated with neoadjuvant chemotherapy. Response to chemotherapy and survival rates were assessed. Results: ORR to NACT was 87.5% (175 cases). Breast conservation eligibility was achieved in 27.5% of patients (55 cases). The 5-year OS rate was 90.3%. Higher OS was associated with postmenopausal status, earlier clinical stages, pathologic complete response (pCR), positive hormonal receptors, and absence of recurrence. The 5-year DFS rate was 85.1%, with higher rates associated with high pathological response, hormone receptor (HR) positivity, and receipt of an optimal course of post-operative radiotherapy (PORT). The only independent statistically significant predictive factor for OS and DFS was pathological response, with p-values of 0.007 and 0.02 respectively. Conclusion: NACT is generally the preferred treatment for women with locally advanced breast cancer (LABC) and high-risk early BC.