***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To evaluate the short-term effects and toxicity of vinorelbine combined with cisplatin ( NP ) as a neoadjuvant chemotherapy regimen in treatment of operable breast cancer non-responsive to the combination of anthracyclines and taxanes .  METHODS Nineteen breast cancer patients , all female , who failed to achieve complete remission ( CR ) or partial remission ( PR ) to the combination of anthracyclines and taxanes as neoadjuvant regimen were treated with 2 cycles of NP regimen ( vinorelbine 25 mg/m(2 ) , on days 1 and 8 and cisplatin 70 mg/m(2 ) , on days 1 and 3 , both by intravenous infusion , as a cycle ) . The clinical objective response was evaluated with dynamic contrast-enhanced MRI of the breast before operation and the pathological response was evaluated by pathological examination . The toxicity of the NP regimen was evaluated according to National Cancer Institute-Common Toxicity Criteria v.3.0 . RESULTS The CR + PR rate of the NP regime was 52.6 % ( 10/19 ) , and pathological response ( G(2 ) + G(3 ) + G(4 ) + G(5 ) ) was found in 17 cases ( 89.5 % , 17/19 ) . The most common toxicities were neutropenia and nausea/vomiting . These toxicities were reversible and did not cause death . CONCLUSION A well-tolerated and effective regimen for breast cancer patient who fail to respond to the combination of anthracyclines and taxanes neoadjuvant chemotherapy , the NP regimen can be considered as an effective choice of second-line regimen . It can be considered as an effective choice of second-line regimen PURPOSE This study was design ed to determine the effect of adding docetaxel ( T ) to preoperative doxorubicin and cyclophosphamide ( AC ) on  breast cancer response rates and disease-free survival ( DFS ) and overall survival ( OS ) . PATIENTS AND METHODS Women with operable breast cancer ( N = 2,411 ) were r and omly assigned to receive preoperative AC followed by surgery , AC followed by T and surgery , or AC followed by surgery and then T. Tamoxifen was initiated concurrently with chemotherapy . Median time on study for 2,404 patients with follow-up was 77.9 months . RESULTS Addition of T to AC did not significantly impact DFS or OS . There were trends toward improved DFS with addition of T. The addition of T reduced the incidence of local recurrences as first events ( P = .0034 ) . Preoperative T , but not postoperative T , significantly improved DFS in patients who had a clinical partial response after AC ( hazard ratio [ HR ] = 0.71 ; 95 % CI , 0.55 to 0.91 ; P = .007 ) . Pathologic complete response , which was doubled by addition of preoperative T , was a significant predictor of OS regardless of treatment ( HR = 0.33 ; 95 % CI , 0.23 to 0.47 ; P < .0001 ) . Pathologic nodal status after chemotherapy was a significant predictor of OS ( P < .0001 ) . CONCLUSION The addition of preoperative or postoperative T after preoperative AC did not significantly affect OS , slightly improved DFS , and decreased the incidence of local recurrences . The sample size of this study was not sufficient to yield significance for the moderate DFS improvement . Concurrent use of tamoxifen may have limited the impact of adding Due to socioeconomic issues , locally advanced breast cancer ( LABC ) is still a common presentation of breast cancer in the third world . It was found that LABC patients showing a clinical response after two to four cycles of neoadjuvant chemotherapy  have a higher probability of obtaining a pathological complete response at surgery than patients without an early response . In the present work , the short-term effects and toxicity of the neoadjuvant second-line vinorelbine and gemcitabine combination were evaluated in the treatment of LABC who did not show early response to anthracyclines and taxanes-containing regimen .  The use of vinorelbine and gemcitabine was based on their use in metastatic breast cancer cases who had been treated before with anthracyclines and taxanes . This was a prospect i ve phase II study accomplished at the Clinical Oncology and Nuclear Medicine Department of Mansoura University , Egypt . Seventy LABC patients not suitable for breast conservative surgery who failed to achieve early response to two cycles of a combination of docetaxel , doxorubicin , and cyclophosphamide ( TAC )  were treated with a 3-weekly regimen of vinorelbine 30 mg/m2 plus gemcitabine 1,200 mg/m2 given on days 1 and 8 by intravenous infusion as a second-line neoadjuvant chemotherapy . Response was assessed after the second cycle . Stable and progressed patients were operated upon while responding cases received up to four cycles before the operation . Patient accrual was from June 20 , 2007 , to October 20 , 2009 . The objective response was evaluated clinical ly with breast sonography before every new cycle and before operation while the pathological response was determined postoperatively . The toxicity was evaluated according to the National Cancer Institute––Common Toxicity criteria version 3 . The end points of this study were clinical response rate , pathological response rate , and treatment toxicity . Clinical response rate was achieved in 35 cases ( 50 % ) while pathological response rate was reported in 4 cases ( 5.7 % ) . Breast conservative surgery ( BCS ) became possible in 31 cases ( 44 % ) . The most common severe toxicities ( grade s 3 and 4 ) were neutropenia and thrombocytopenia in 25.7 and 22.8 % of cases , respectively . Toxicities were reversible and did not cause death . It is possible to achieve objective clinical and pathological responses of LABC with potentially non-cross-resistant neoadjuvant second-line therapy , leading to BCS in a high proportion of patients . Thus , preoperative second-line chemotherapy appears to be justified when breast conservation is an important treatment goal Only a few papers have been published concerning the incidence and outcome of patients with a pathological complete response after cytotoxic treatment in breast cancer . The purpose of this retrospective study was to assess the outcome of patients found to have a pathological complete response in both the breast and axillary lymph nodes after neoadjuvant chemotherapy for operable breast cancer . Our goal was also to determine whether the residual pathological size of the tumour in breast could be correlated with pathological node status . Between 1982 and 2000 , 451 consecutive patients were registered into five prospect i ve phase II trials . After six cycles , 396 patients underwent surgery with axillary dissection for 277 patients ( 69.9 % ) .  Pathological response was evaluated according to the Chevallier 's classification . At a median follow-up of 8 years , survival was analysed as a function of pathological response . A pathological complete response rate was obtained in 60 patients ( 15.2 % ) after induction chemotherapy . Breast tumour persistence was significantly related to positive axillary nodes ( P=5.10−6 ) . At 15 years , overall survival and disease-free survival rates were significantly higher in the group who had a pathological complete response than in the group who had less than a pathological complete response ( P=0.047 and P=0.024 , respectively ) . In the absence of pathological complete response and furthermore when there is a notable remaining pathological disease , axillary dissection is still important to determine a major prognostic factor and subsequently , a second non cross resistant adjuvant regimen or high dose chemotherapy could lead to a survival benefit Abstract Background : Neoadjuvant anti-tumor activity of an alternating taxane- and anthracycline-based dose-dense regimen in patients with operable , noninflammatory large breast cancer was investigated . Objective : The objective is to study the rate of pathological complete response in patients with breast cancer receiving dose-dense chemotherapy sequentially with gemcitabine plus docetaxel and vinorelbine plus epirubicin .  Methods : Women ( n = 74 ) with clinical stage II or III breast cancer were enrolled in this open-label , multicenter study to receive six 2-weekly courses of gemcitabine 1000 mg/m2 plus docetaxel 75 mg/m2 on days 1 and 15 , and vinorelbine 25 mg/m2 plus epirubicin 100mg/m2 on days 29 and 43 . Patients with an objective response on day 56 then received another cycle of gemcitabine/ docetaxel on day 57 and of vinorelbine/epirubicin on day 71 . Conservative surgery was scheduled for all patients . Results : Of the patients enrolled , 30 % had triple-negative breast cancer ( TNBC ) . The pathologic complete response ( pCR ) rate was 22 % overall , but was higher in TNBC than patients without TNBC ( 40.9 % vs 14.0 % ; p=0.028 ) . Among patients with a pCR , patients with TNBC had similar recurrence-free survival ( RFS ) and overall survival ( OS ) to patients without TNBC . Among those without a pCR , RFS rates for patients with TNBC were significantly lower than for patients without TNBC ( p=0.04 ) . The most common severe hematologic toxicity was neutropenia . Conclusions : Administering four drugs in a dose-dense alternating sequence gave a high pCR in patients with operable , invasive breast cancer . Patients with TNBC with a pCR had similar OS to patients without TNBC , whereas patients with TNBC without a pCR had poorer survival rate than their non- TNBC counterparts National Surgical Adjuvant Breast and Bowel Project ( NSABP ) Protocol B-18 was initiated in 1988 to determine whether four cycles of doxorubicin/cyclophosphamide given preoperatively improve survival and disease-free survival ( DFS ) when compared with the same chemotherapy given postoperatively . Secondary aims included the evaluation of preoperative chemotherapy in downstaging the primary breast tumor and involved axillary lymph nodes , the comparison of lumpectomy rates and rates of ipsilateral breast tumor recurrence ( IBTR ) in the two treatment groups , and the assessment of the correlation between primary tumor response and outcome . Initially published findings were based on a follow-up of 5 years ; this report up date s results through 9 years of follow-up . There continue to be no statistically significant overall differences in survival or DFS between the two treatment groups . Survival at 9 years is 70 % in the postoperative group and 69 % in the preoperative group ( P = .80 ) . DFS is 53 % in postoperative patients and 55 % in preoperative patients ( P = .50 ) . A statistically significant correlation persists between primary tumor response and outcome , and this correlation has become statistically stronger with longer follow-up . Patients assigned to preoperative chemotherapy  received notably more lumpectomies than postoperative patients , especially among patients with tumors greater than 5 cm at study entry . Although the rate of IBTR was slightly higher in the preoperative group ( 10.7 % versus 7.6 % ) , this difference was not statistically significant . Marginally statistically significant treatment-by-age interactions appear to be emerging for survival and DFS , suggesting that younger patients may benefit from preoperative therapy , whereas the reverse may be true for older patients Background Since the introduction of breast-conserving surgery ( BCS ) , it has been increasingly accepted as the st and ard surgical option for suitable breast cancer patients in Western countries . However , there have been reports suggesting striking ethnic variations in those undergoing BCS . This study aim ed to review the rate of  BCS  in Hong Kong Chinese breast cancer patients and the possible clinicopathologic and psychosocial factors that may have affected the choice of surgery . Methods Patients in a university academic surgical center with early-stage breast cancer ( stage I/II invasive carcinoma and carcinoma in situ ) who underwent definitive surgery from January 2001 to December 2005 were studied . BCS was considered feasible for those with ( 1 ) the optimal tumor size for which an acceptable cosmetic outcome can be achieved after surgery , ( 2 ) unifocal disease , and ( 3 ) no contraindication for postoperative radiotherapy . The proportion of women undergoing BCS or mastectomy were compared . Factors affecting the choice of surgery were correlated . Results Six hundred eighty female patients with early-stage breast cancer underwent surgery during the study period ; 495 ( 72.8 % ) mastectomies , 149 ( 21.9 % ) BCS , and 36 ( 5.3 % ) mastectomies with immediate reconstruction were performed . For those patients who had mastectomies , 54.8 % ( 271/495 ) had considered BCS as the initial surgical option . Among these , 19.6 % ( 53/271 ) failed to have BCS performed due to margin involvement or extensive disease , and 80.4 % ( 218/271 ) declined BCS and opted for mastectomy only . Age , marital status , and educational level were found to be independent significant factors affecting the choice of BCS . Conclusion The rate of BCS  in Hong Kong is relatively low compared to that of Western countries . Patients who opted for mastectomies tended to be older , married , and have a lower educational level . Prospect i ve studies on how sociocultural , clinicopathologic , and other factors important in treatment decision-making processes and psychosocial impact of choice of surgery are important so that an ethnic-specific assessment can be made . Suitability and acceptance of BCS  by Chinese women should increase with better underst and ing 
    Output:
    
The present review confirms that neoadjuvant chemotherapy vinorelbine-based regimens are unlikely to emerge as superior to pCR , ORR and BCS .
Hierarchical analysis indicated that the HER2-amplified and hormone receptor-negative patients were significantly associated with a pathological response rate