WHAT WE ALREADY KNOW
Globally, locally advanced breast cancer (LABC) (Clinical stages IIB(T3) –IIIC is the most common presentation of this malignancy. In many low and middle income countries, one half to 90% of cases are first diagnosed when in these stages (For example data from rural Bangladesh accessible at agbreastcare.org). At present about two thirds of new breast cancer cases annually occur in low and middle income countries, and among poor women.
Even with state of the art (western high income country) treatment approaches, a majority of women with these presentations of disease die within five years, and the overwhelming majority of all women with LABC rarely get reasonable, comprehensive treatment. There is thus a significant need to define more effective and practical treatment for LABC.
The summary findings about treatment are that:
1. Neoadjuvant (i.e. first before any surgery) systemic chemotherapies can achieve complete responses with disappearance of all pathological evidence of cancer in LABC, which approach circumvents the growth-promoting effects on micro-metastases of sudden surgical removal of a primary tumor;
2. Very recent data are that MUCH higher rates of responses to treatment are associated with improved disease free and overall survivals when both neoadjuvant chemotherapy and radiation therapy are used concurrently;
3. Significantly high disappearance of all cancer rates are suggested in primary tumors which are triple negative (that is have no evidence of estrogen, or progesterone receptors or Her-2/neu oncogene overexpression);
together with the relatively low cost of certain useful and critical chemotherapy drugs, suggest that significantly better outcomes for women with LABC in low and middle income counties may now be possible.
THE BIG ISSUE
CAN A CONCURRENT CHEMOTHERAPY AND RADIATION THERAPY TREATMENT PROGRAM FOR LABC DEVELOPED IN THE UNITED STATES BE SUCCESSFULLY APPLIED IN DIFFERENT TREATMENT CIRCUMSTANCES IN SOUTHEAST ASIA AND ACHIEVE SIMILAR EXCELLENT RESULTS?
Locally Advanced Breast Cancer Project 1:
A clinical trial of concurrent neoadjuvant paclitaxel chemotherapy and radiation therapy in triple negative locally advanced breast cancer
The major objectives of this IBCRF sponsored study in Malaysia, Vietnam, Philippines, Singapore and Thailand are
1. In 100 women with stage IIB (T3)-stage IIIC LABC, which is ER, PR and Her-2neu negative, to determine the pathologic complete and partial response rate to neoadjuvant treatment with concurrent weekly paclitaxel chemotherapy and radiation therapy to the breast tumor; and
2. Describe toxicities associated with this treatment approach.
