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Breast cancer is the commonest malignancy in women internationally, with nearly 2 million new patients diagnosed in 2018 (it ranks second in most common malignancy overall).( Bray, et al., 2018). Locally advanced breast cancer; are the most advanced and aggressive breast tumors in the absence of distant metastasis. It has been recognized that multimodality approach of treatment (surgery, chemotherapy, radiotherapy and hormonal and targeted therapy if required) can significantly improve the prognosis in these group of patients.(Kumar, 2015) LABC has been described by the U.S. National Comprehensive Cancer Network as stage III breast cancer; the definition includes breast cancer with the following criteria in the absence of distant metastasis: Tumors mass ≥5 cm in size (T 3) +/-pathological enlarged lymph nodes (N1–3) Tumors of any size that infiltrate the chest wall and/or the skin (T4), regardless the regional lymph nodes status. Tumors of any size with the presence of regional pathologically enlarged lymph nodes (clinically fixed or amalgamated axillary lymph nodes, or any of; infraclavicular, supraclavicular, or internal mammary LNs).(Kumar, 2015) Immunohistochemistry (IHC) testing of cancer cells collected with a core needle biopsy or surgery will be done to evaluate the estrogen and progesterone receptors status. When the hormones estrogen and progesterone attach to these receptors, this reaction promotes the growth of the cancer. Information about the hormone receptor status is critical to decide the optimal treatment
options. Women with hormone receptor positive (HR +ve) cancers tend to have a better outcomes in the short-term, but these subtype of breast cancer can sometimes presents with recurrence after years following completion of treatment. This subtype of breast cancer is more common in menopausal females. Hormone receptor negative (HR -ve) breast cancers have neither estrogen nor progesterone receptors. These cancers tend to grow faster than HR +ve cancers. If they recurrent after treatment, it’s often in the first few years. They are more common in premenopausal females.(Alteri, et al., 2017).
Hormone receptor positive breast cancer is the commonest type of breast cancer, which represents 70-80 % of all breast carcinomas.(Bardia, et al., 2017).
Neoadjuvanttherapy; is the administration of chemotherapy before surgery and has been used for over twenty years for the aim of down staging locally advanced and inoperable breast cancers to make them operable (Bardia, et al., 2017).
The selection of neoadjuvant chemotherapy are based on the same algorithm for adjuvant therapy. Recently, breast cancer was recognized as a heterogeneous disease in which the thought of that one treatment program will beneficial to all cases is not realistic and tailored therapies are more acceptable.(Colleoni and Montagna 2012)
Neoadjuvant chemotherapy (NAC) has traditionally been the standard management of LABC for the aim of downstaging and facilitating conservative breast surgery (CBS). The selection of the neoadjuvant therapy drug combinations depends on testing the tumor core needle biopsy for hormonal receptors (ER, PR) and humman epidermal growth factor receptor 2 (HER2) status.