Abstract

KHAMAJEET, A et al. Pathological response of breast cancer to neoadjuvant chemotherapy at a single tertiary centre. S. Afr. j. surg. [online]. 2025, vol.63, n.2, pp.68-73. ISSN 2078-5151.  https://doi.org/10.36303/SAJS.01118.

BACKGROUND: Neoadjuvant chemotherapy (NACT) is standard treatment for eligible breast cancer patients. While guidelines recommend combining chemotherapy with trastuzumab for HER2-positive breast cancer, Groote Schuur Hospital is unable to provide trastuzumab due to cost constraints. This study examines the pathological response of breast cancer patients who received NACT, with a particular focus on HER2-positive breast cancer patients who did not receive targeted therapy, trastuzumab, in the neo-adjuvant setting. METHODS: A retrospective audit was conducted on patients who received NACT followed by surgery between January 2017 and December 2018 at a tertiary hospital in Cape Town. Data on baseline tumour size, axillary staging, molecular subtype, and treatment response were analysed. RESULTS: Out of 160 patients, 97.5% were female (n = 156) and 88% underwent mastectomy. Infiltrating ductal carcinoma was the most common histology (94%). Pathological complete response (pCR) was achieved by 21% of patients, and 79% had residual disease. Triple-negative breast cancer showed the best pathological response, with a 31% pCR rate (p < 0.005), while ER-positive/HER2-negative patients had a poor pCR rate of 2.4% (p < 0.005). ER-negative/HER2-positive patients had a 6.7% pCR rate (p = 0.147). CONCLUSION: NACT is most effective for triple-negative breast cancer patients, while ER+ve/HER2-ve showed the poorest response. HER2-positive patients, all not receiving trastuzumab, showed a much lower response compared to the international norm when trastuzumab was available. Adding trastuzumab should improve pCR rates for HER2-positive patients.

Keywords : neoadjuvant chemotherapy; breast cancer; trastuzumab; resource constrained setting; pathological complete response.

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