International Clinical and Medical Case Reports Journal (ISSN: 2832-5788) | Volume 1, Issue 3 | Research Article | Open Access

Four versus Six Cycles of Neoadjuvant Chemotherapy in Premenopausal Women

Fabian Ugonna Olisa*

Consultant General Surgeon, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital Abalaliki, Nigeria

*Correspondence to: Fabian Ugonna Olisa 

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Background: Breast cancer in Nigeria occurs mainly in premenopausal women and is seen at an advanced stage of the disease resulting in its poor survival rate. Achieving local disease control in Locally Advanced Breast Cancers (LABC) affecting premenopausal women remains a challenge. Neoadjuvant Chemotherapy (NAC) is the standard of care for LABC. Although response after the initial cycles is maximal, toxicity, however is profound after the fourth cycle.

Objective: To determine the reductions in size of a primary tumour, and adverse effect profiles when 4 and 6 cycles of NAC are used in premenopausal women with clinically confirmed LABC in FETHA.

Methodology: This was a twelve-month prospective, comparative randomised study of premenopausal women with histologically confirmed and clinically diagnosed LABC at FETHA. Patients were randomized into two groups (A and B). Group A received four cycles, and group B received six cycles of NAC. Cyclophosphamide and Adriamycin were administered as NAC. Observed effects were documented. Data collected were demographics, primary tumour size at the onset of NAC, difference in primary tumour size between cycles in each group, difference in tumour size three weeks after the fourth or the sixth cycle of NAC, difference in the values of the hematological profiles between cycles in each group, and other non-hematological toxicities.

Data was analysed using Statistical Package for Social Sciences (SPSS) Version 20. Continuous data were presented as means and standard deviation while categorical data were presented as frequencies and percentages. Students T test and Chi square tests were used to compare continuous and categorical data repectively.Statistical significance was set at P less than 0.05.

Result: Thirty-six patients were recruited into groups A and B; 18 patients in each group. The mean age for groups A and B were 39.50 ± 4.37 years and 36.89 ± 4.75 years. The mean reduction in size of the primary tumour at the end of NAC in groups A and B were 7.78 ± 5.24cm and 8.07 ± 7.04cm (P= 0.899). Maximum response was noted after the first and second cycles in both groups of the study. The mean percentage response of the primary tumour at the end of NAC for groups A and B were 37.80 ± 24.89% and 38.16 ± 45.86% respectively (P= 0.977).

The mean reduction in absolute neutrophil count (ANC) at the end of NAC in groups A and B were 0.48 × 103/mm3 and 1.31 × 103/mm3 respectively with a p value of 0.002. Alopecia was the most common adverse effect. Fever occurred more in patients that received six cycles.

Conclusion: No significant size reduction was noted after the fifth and sixth cycles of NAC. Four cycles of NAC achieved reduction of the primary tumour size similar to six cycles. Adverse effects occurred more when six cycles were given.


Neoadjuvant Chemotherapy; Locally Advanced Breast Cancer; Premenopausal women


Fabian Ugonna Olisa, Uche Emmanuel Eni, Aloysius Ugwu-Olisa Ogbuanaya, Emmanuel Olawale Boladuro.Four versus Six Cycles of Neoadjuvant Chemotherapy in Premenopausal Women.Int Clinc Med Case Rep Jour. 2022;1(3):1-12.