Neoadjuvant chemotherapy for breast cancer with weekly nab-paclitaxel followed by epirubicin and cyclophosphamide--results of a case series.

BACKGROUND/AIM: To substitute paclitaxel in neoadjuvant chemotherapy of breast cancer by nab-paclitaxel due to its improved efficacy and safety profile.

PATIENTS AND METHODS: Sixteen patients with primary breast cancer received neoadjuvant chemotherapy with 4 cycles of nab-paclitaxel at 150 mg/m(2) (d1, 8, 15, every 28 days followed by 4 cycles of epirubicin at 90 mg/m(2) d1, every 21 days and cyclophophosphamide at 600 mg/m(2) (d1, every 21 days plus, if human epidermal growth factor receptor 2 (HER2)-positive, trastuzumab, and in 2 cases trastuzumab and lapatinib. End-points were the rate of pathological complete response (pCR) and safety.

RESULTS: All patients responded after two cycles. Overall, 11/16 patients had pathological complete response: 5/6 with HER2-positive, 3/4 with triple-negative and 3/6 with HER2-negative, hormone receptor-positive disease. Adverse events of grade 3 or more occurred in 4 patients. There were no grade 4 or 5 toxicities. The most frequent side-effects (all grades) were peripheral polyneuropathy (n=11, n=4 grade 2), fatigue (n=9) and hand-foot syndrome (n=8). Overall, side-effects were easily managed.

CONCLUSION: Neoadjuvant chemotherapy with nab-paclitaxel is a good alternative to paclitaxel-based regimens.