Research Article ISSN 2639-8478

Research Article Cancer Science & Research

Breast Cancer Chemotherapy In Pointe Noire

Ngatali, C.F.S1*, Moukassa, D3 and Nkoua-Mbon, JB2
Department of Oncology and Internal Medicine, Loandjili
1

General Hospital (Congo). *

Correspondence:
Ngatali Christian, Loandjili General Hospital and Faculty of
Medical Oncology
2
Department, Teaching Hospital of Health Sciences, Brazzaville.
Brazzaville (Congo).
Received: 28 Jan 2022; Accepted: 18 Feb 2022; Published: 25 Feb 2022
3
Hospital General, Edith Lucie Bongo (Congo).

Citation: Ngatali CFS, Moukassa D, Nkoua-Mbon JB. Breast Cancer Chemotherapy In Pointe Noire. Cancer Sci Res. 2022; 5(1): 1-5.

ABSTRACT
Objective: The objective of our study was to determine chemotherapy and these frequent side effects of breast
cancer in Pointe-Noire.

Patients and Methods: This was a retrospective descriptive study that took place in the cancerology and internal
medicine department during the period from January 1, 2019 to December 31, 2021. Were included in our study:
patients with and histological diagnosis, and having received at least one course of chemotherapy and having
presented hematological toxicity: anemia and/or neutropenia. Patients having status performances less than 2. The
variables studied were: Age, level of study, stage of extension, type of chemotherapy, type of toxicity. L4ANA The
khi2 was used and results were statistically significant for a value of P<5%.

Results: The average age of the patients was 50.35 ± 13.6 years. The extremes were 27 years and 79 years old. The
most represented age group was the age group from 37 to 46 years with 18 cases or 33.33%. The most represented
level study in our study was the primary level 70%, followed by secondary level 26% and the upper or superior level
11%. Metastatic stage of location was represented in 16.6% of cases, the local stage was represented in 16.7% of
cases. The most commonly chemotherapy used was FAC protocol in 50% of cases, followed by FAC+DOCETAXEL
in 47% of cases, AC protocol was used in 3% of cases The majority of patients had received more than 3 courses
of chemotherapy in 83% of cases case. Frequent toxicities were fatigue 100%, alopecia 100%, nausea 100%,
hematological 95%, vomiting 20%. The most used chemotherapy was FAC type chemotherapy in 19 cases, 4 cases,
2 cases respectively at the locoregional, metastatic and local stages.

Conclusion: Chemotherapy for breast cancers in our context with limited resources is of the anrhracyclines (AC,
FAC) and taxanes (docetaxel) type. These chemotherapies are responsible for haematological toxicities, fatigue,
nausea, vomiting and alopecia.

Keywords are classically classified into three categories: endocrine or

Chemotherapy, Breast cancer, Side effects, Pointe-Noire, Congo hormonal therapy, targeted therapies, including anti HER2, and
Brazzaville. chemotherapy. Various combinations of these classes of drugs
are given as either an adjuvant or neoadjuvant regimens. The
Introduction adjuvant therapy follows the primary treatment by surgery with
Breast cancer is the leading cancer and the leading cause of or without radiation to decrease the risk of distant recurrence
cancer death in women worldwide [1-6]. In low income countries, in an approach that proved to improve outcomes and survival
breast cancer is often diagnosed at advanced stages and has rates [7,8]. In contrast, neo-adjuvant regimens are given before
a poor prognosis [6]. Drug therapies used for breast cancer surgery to downsize or downstage the tumor in the cases of locally

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advanced or large tumors[8,9]. Chemotherapy is an essential - type of chemotherapy
component in many cases of breast cancer, and different classes of - toxicity
cytotoxic agents are being used. The main chemotherapy classes
used are anthracyclines, anti-microtubules (taxanes), alkylating The stage of extension was grouped in local (stage 0 and I),
agents (cyclophosphamide), antimetabolites (5-fluorouracil, locoregional or advanced (stage II and III) and metastatic for stage IV.
capecitabine), platinum compounds (cisplatin), and others. These
drugs are usually given in multiple-drug regimens, which proved The collection of data was made from a previously written survey
to be superior to single agents in terms of efficacy and safety[10]. sheet, containing the different variables studied. Data entry was
However, in cases of advanced breast cancer, some chemotherapies done using the Excel version 2016 software. Qualitative variables
are given as single agents. were represented in terms of number and percentage. Quantitative
variables were represented effective and on average. The statistical
Neoadjuvant chemotherapy (NACT), or preoperative analysis and the data processing were carried out by the Excel 2016
chemotherapy, was introduced in the treatment of locally advanced software and the graphpad prism version 7 software. The statistical
breast cancer in the 1980's. test used was the chi square test.

The major advantage of NACT is downsizing the tumor and Results

downstaging the axilla. By downstaging, possible metastases 70 files had met the inclusion criteria. The average age of the
to axillary lymph nodes are reduced. Downsizing breast tumors patients was 51 ± 12 years. The extremes were 27 years and 79
facilitates conversion of inoperable tumors to operable ones and years old. The most represented age group was the age group from
enables the surgeon to offer minor surgery or breast-conserving 37 to 46 years with 24 cases or 34% Table1. The most represented
surgery (BCS) instead of mastectomy [11-13]. level study in our study was the primary level 70%, followed by
secondary level 22% and the upper or superior level 8%Table1.
Thereby, the possibility of mastectomy and immediate breast The majority of patients presented at locoregional stage in 58%
reconstruction (IBR) is enhanced. The increased utilization of cases, local stage was represented in 6% of cases while the
of NACT has resulted in 16–17% of the patients converting metastatic stage was represented in 30% of cases. Table1. The most
from mastectomy to breast conserving surgery and mastectomy used chemotherapy was anthracyclines (FAC) in 50% of cases
followed by radiationtherapy [12,14]. Chemotherapy causes many followed by fac +docetaxel regimens in 46% and AC regimens in
side effects that can reduce. 6% Table 2. Most of the patients received more than 3 Cycles of
chemotherapy in 80% of cases, 20% received less than 3 Cycles
In Congo, to our knowledge, no study has been carried out, so we set Table 3. Frequent toxicities were fatigue 100%, alopecia 100%,
ourselves the objective of determining the types of chemotherapy nausea 100%, hematological 95%, vomiting 20% Figure 1. The
and their side effects in patients with breast cancer in Pointe-Noire. bivariate analysis showed that the most used chemotherapy was
FAC type chemotherapy in 19 cases, 4 cases, 2 cases respectively
Patients and Methods at the locoregional, metastatic and local stages. FAC + docetaxel
This was a cross-sectional descriptive study that took place in the sequential chemotherapy was the second most used chemotherapy
cancerology and internal medicine department during the period in 10 cases, 9 cases, 4 cases respectively for the metastatic,
from January 1, 2019 to December 31, 2021, i.e. a period of 3 locoregional and local stages Table 3.
years. The following were included in our study: patients with
a histological diagnosis of cancer and an extension assessment Table 1: Distribution of patients according to sociodemographics and
made of a thoraco-abdominal CT scan and/or a chest X-ray and an clinical characteristics.
abdominal ultrasound, all patients who had hematological toxicity Characteristics Number (50) Percentage (%)
(anemia and/ or neutropenia) discovered by complete blood count; Age groups
patients who have received at least one cycles of chemotherapy 27-36 4 8
for breast cancer in a neoadjuvant or adjuvant setting; patients 37-46 20 40
47-56 14 28
having status performances less than 2. The type of chemotherapy
57-66 7 14
used was alone or in combination or séquential. chemotherapy
67-76 4 8
and radiation Chemotherapy was neoadjuvant or adjuvant or 77-86 1 2
sequential. Study level
Primairy 35 70
The data was collected from the records of patients hospitalized in Secondary 11 22
the department for breast cancer. Superior 4 8
Stage of extension
The variables studied were: Local 6 12
- socio-demographic: age, level of study, socio-economic level Locoregional 29 58
- clinics: internship extension Metastatic 15 30

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Table 2: distribution of patients according to type of chemotherapy. age groups in African countries, especially those in developmental
Type of chemotherapy Number Percentage pathways. This could be explained on the one hand by the
FAC 25 50 composition of the African population which is a young population
FAC+TAXOTERE 23 46 and on the other hand by the probable increase in the incidence
AC 2 4 of breast cancer in this age group but also by the development
Total 50 100 diagnostic and therapeutic techniques. In fact, the population of
developed countries is aging and age is a risk factor for breast
Table 3: distribution of patients according to Number of cycles.
cancer. The level of study in our study was primary in our study
Number of Cycle Number Percentage
in 70% of cases, followed by the secondary level 22% of cases. In
<3 10 20
≥3 40 80
developing countries, patients had a primary level of education or
Total 50 100 were illiterate [19]. In developed countries, particularly in the US,
the highest level of education is the highest level [20,21].

Type of chemotherapy
The chemotherapy protocols used in our study were protocols
based on anthracyclines (FAC and AC) but also based on taxanes.
These treatments were used in a neoadjuvant or adjuvant setting.

The benefit of adjuvant chemotherapy was well established by

the 1980s. A meta‐analysis including 40 adjuvant chemotherapy
trials in over 13,000 breast cancer patients showed multiagent
chemotherapy reduced the annual odds of death by about one
quarter in the initial 5 years after treatment for women under 50
[22]. Although many of these early data supported the use of the
combination of cyclophosphamide, methotrexate, and fluorouracil
(CMF), advanced breast cancer studies in the 1980s suggested
Figure 1: distribution of patients according to toxicity. greater activity of anthracycline-containing regimens based on
higher response rates and response durations [23]. Subsequently,
Table 4: distribution of patients according to type of chemotherapy and multiple randomized trials compared adjuvant anthracycline-based
stage of extension. chemotherapy regimens with CMF and suggested a diseases free
Type of Chemotherapy Survival and overall survival benefit with adjuvant anthracyclines
Stage of extension FAC FAC+TAXOTERE AC Total [24-26].
Local 2 4 0 6
Locoregional 19 9 1 29 One study established the anthracycline‐and taxane chemotherapy
Metastatic 4 10 1 15 protocol as a standard for adjuvant treatment. Notably, the absolute
Total 25 23 2 50
benefit is relatively small, indicating only a small subset of
P>5% Non significant result patients with invasive breast cancer derive benefit from adjuvant
anthracyclines when compared with other adjuvant chemotherapy
Discussion regimens [27]. Other authors have used anyhracyclines in 54% of
The average age of the patients in our study was 51 ± 12 years, the cases [28].
extremes were 27 years and 79 years. Breast cancer affects women
at a relatively young age. The average age was relatively young, In our study 80% of the patients had received more than 3 cures
this average age of the patients in our study was found by most in our study, indeed this could be explained by the fact that they
authors in Africa with averages of 47.5 ± 12.36; 47.97 respectively arrived at the advanced stages.
described by Ngowa J et al. [15], Cameroon and Mensah et al
Ghana [16]. On the other hand, in developed countries in the USA, Toxicity
for example, the average age of breast cancer patients was 61 years Anthracycline-associated adverse events are considered as a
with the extremes of 55 years and 64 years [17]. In Saudi Arabia significant limiting factor in utilizing these powerful cytotoxic
the average age found was also relatively young 47.16 ± 12.15 agents. These events include mainly cardiotoxicity that might
[18]. The age group most represented in our study was 37 to 46 occur as acute toxicity manifested by arrhythmias or depressed
years of age, followed by the age group 47 to 56, the younger ejection fraction, particularly in the left ventricle (LVEF) or
age groups. These age groups were close to the age groups of the might be chronic that develops years after the anthracycline use
majority of African countries [15,16]. In the US, the most affected [29]. In addition to their cardiac effects, hematological toxicity,
age group was 54 at age 65 [17]. The age groups of patients in gastrointestinal toxicity, and febrile neutropenia events are all
both developed and US countries are quite high age groups, unlike among the dose-limiting side effects of anthracyclines [29].

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In our study we observed the following adverse effects: fatigue, 6. Lauby-Secretan B, Scoccianti C, Loomis D, et al. International
alopecia, nausea, vomiting, and hematological toxicity. According Agency for Research on Cancer Handbook Working Group.
to Montemurro et al [30] symptom incidence after the third Breast-Cancer Screening Viewpoint of the IARC Working
cycle was highest for fatigue (78%), nausea (73%), dysgeusia Group. The New England Journal of Medicine. 2015; 372:
(51%), anorexia (53%), and constipation (49%). Toxicity results 2353-2358.
were presented for all chemotherapy regimens combined, not 7. Anampa J, Makower D, Sparano JA. Progress in adjuvant
separately for the chemotherapy regimens in the sample—5‐ chemotherapy for breast cancer an overview. BMC Med.
fluorouracil/epirubicin/ cyclophosphamide (64%), doxorubicin/ 2015; 13: 195.
cyclophosphamide or epirubicin/cyclophosphamide (22%), or 8. Carels N, Spinassé LB, Tilli TM, et al. Toward precision
docetaxel/cyclophosphamide (14 %). In general, few studies report medicine of breast cancer. Theor Biol Med Model. 2016; 13:
toxicities for individual chemotherapy regimens [31], and these 7.
were mostly for single‐symptom studies such as fatigue [32,33].
9. Joseph K, Vrouwe S, Kamruzzaman A, et al. Outcome
analysis of breast cancer patients who declined evidence-
Type of chemotherapy and stage of extension
based treatment. World J Surg Oncol. 2012; 10: 118.
The bivariate analysis showed that the most used chemotherapy
was FAC type chemotherapy in 19 cases, 4 cases, 2 cases 10. González Neira A. Pharmacogenetics of chemotherapy
respectively at the locoregional, metastatic and local stages. FAC efficacy in breast cancer. Pharmacogenomics. 2012; 13: 677-
+ docetaxel sequential chemotherapy was the second most used 690.
chemotherapy in 10 cases, 9 cases, 4 cases respectively for the 11. Thompson AM, Moulder-Thompson SL. Neoadjuvant
metastatic, locoregional and local stages. But this result ws not treatment of breast cancer. Ann Oncol. 2012; 23: x231-x236
signufucant. First this result of the use of fac or anthracylices in 12. Ataseven B, von Minckwitz G. The impact of neoadjuvant
our context of limited resources can be explained by the high cost treatment on surgical options and outcomes. Ann Surg Oncol.
of taxane-based chemotherapy. And the second reason was that 2016; 23: 3093-3099.
most of patients was in advanced stage.
13. Pathak M, Deo SS, Dwivedi S, et al. Role of neoadjuvant
chemotherapy in breast cancer patients systematic review and
Conclusion meta-analysis. Indian J Med Paediatr Oncol. 2019; 40: 48.
Chemotherapy for breast cancers in our context with limited
14. González Neira A. Pharmacogenetics of chemotherapy
resources is of the anrhracyclines (AC, FAC) and taxanes
efficacy in breast cancer. Pharmacogenomics. 2012; 13: 677-
(docetaxel) type. The most commly chemotherapy used in our
690.
limited resources context is anthracycines based regims. These
chemotherapies are responsible for haematological toxicities, 15. Jean Dupont Kemfang Ngowa, Jean Marie Kasia, Jean Yomi,
fatigue, nausea, vomiting and alopecia. The cost reduction taxanes et al. Breast Cancer survival in Cameroun Analysis of a cohort
regimens will help patients to receive more chemotherapy based of 404 patients at Yaoundé General Hospital. Advances in
on taxanes. Breast Cancer Research. 2015; 4: 44-52.
16. Mensah A, Yarney J, Nokoe S, et al. Survival Outcomes of
References Breast Cancer in Ghana: An Analysis of Clinicopathological
1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics Features. Open Access Library Journal. 2016; 3: 1-11.
2020 GLOBOCAN Estimates of Incidence and Mortality 17. Hope S, Rugo, Melanie Majure, et al. Neoplasme of breast
Worldwide for 36 Cancers in 185 Countries. CA Cancer J Cancer Medecine. Edition. 2017; 9: 1368-1438.
Clin. 2021; 71: 209-249. 18. Al Isawi A. Breast Cancer in Western Iraq: Clinicopathological
2. Jemal A, Bray F, Center MM, et al. Global Cancer Statistics. Single Institution Study. Advances in Breast Cancer Research.
CA A Cancer Journal for Clinicians. 2011; 61: 69-90. 2016; 5: 83-89.
3. Bray F, Ferlay J, Soerjomataram I, et al. Global Cancer 19. Gueye M, Gueye S, Diallo M, et al. Sociodemographic Factors
Statistics GLOBOCAN Estimates of Incidence and Mortality Associated with Delays in Breast Cancer. Open Journal of
Worldwide for 36 Cancers in 185 Countries. CA A Cancer Obstetrics and Gynecology. 2017; 7: 455-463.
Journal for Clinicians. 2018; 68: 394-424. 20. Dieterich M, Stubert J, Reimer T, et al. Influence of life style
4. Gullatte M, Phillips J, Gibson L. Factors Associated with factors on breast cancer risk. Breast cancer Basel. 2014; 9:
Delays in Screening of Self-Detected Breast Changes in 407-414.
African-American Women. Journal of National Black Nurses 21. Cuzick J. Assessing risk for breast cancer. Breast Cancer Res.
Association. 2006; 17: 45-50. 2008; 10: S13.
5. Brahim NA, Odusanya OO. Knowledge of Risk Factors, 22. Early Breast Cancer Trialists' Collaborative Group. Effects
Beliefs and Practices of Female Healthcare Professionals of adjuvant tamoxifen and of cytotoxic therapy on mortality
towards Breast Cancer in a Tertiary Institution in Lagos in early breast cancer. An overview of 61 randomized trials
Nigeria. BMC Cancer. 2009; 9: 76. among 28,896 women. N Engl J Med. 1988; 319: 1681-1692.

Cancer Sci Res, 2022 Volume 5 | Issue 1 | 4 of 5

23. Aisner J, Weinberg V, Perloff M, et al. Chemotherapy versus 28. Kirsten A Nyrop, Allison M Deal, Shlomit S Shachar, et al.
chemoimmunotherapy CAF v CAFVP v CMF each +/‐ MER Patient‐Reported Toxicities During Chemotherapy Regimens
for metastatic carcinoma of the breast A CALGB study Cancer in Current Clinical Practice for Early Breast Cancer.
and Leukemia Group B. J Clin Oncol. 1987; 5: 1523-1533. Oncologist. 2019; 24: 762-771.
24. Ejlertsen B, Mouridsen HT, Jensen MB, et al. Improved 29. Schneider BP, Shen F, Gardner L, et al. Genome-Wide
outcome from substituting methotrexate with epirubicin Association Study for Anthracycline Induced Congestive
Results from a randomised comparison of CMF versus CEF Heart Failure. Clin Cancer Res. 2017; 23: 43-51.
in patients with primary breast cancer. Eur J Cancer. 2007; 30. Montemurro F, Mittica G, Cagnazzo C, et al. Self evaluation
43: 877-884. of adjuvant chemotherapy‐related adverse effects by patients
25. Coombes RC, Bliss JM, Wils J, et al. Adjuvant with breast cancer. JAMA Oncol. 2016; 2: 445-452.
cyclophosphamide methotrexate and fluorouracil versus 31. Hall E, Cameron D, Waters R, et al. Comparison of patient
fluorouracil epirubicin and cyclophosphamide chemotherapy reported quality of life and impact of treatment side effects
in premenopausal women with axillary node positive operable experienced with a taxane‐containing regimen and standard
breast cancer Results of a randomized trial. The International anthracycline based chemotherapy for early breast cancer 6
Collaborative Cancer Group J Clin Oncol. 1996; 14: 35-45. year results from the UK TACT trial CRUK/01/001. Eur J
26. Levine MN, Bramwell VH, Pritchard KI, et al. Randomized Cancer. 2014; 50: 2375-2389.
trial of intensive cyclophosphamide epirubicin and fluorouracil 32. Jong N, Candel MJ, Schouten HC, et al. Prevalence and
chemotherapy compared with cyclophosphamide methotrexate course of fatigue in breast cancer patients receiving adjuvant
and fluorouracil in premenopausal women with node‐positive chemotherapy. Ann Oncol. 2004; 15: 896-905.
breast cancer. National Cancer Institute of Canada Clinical
33. Junghaenel DU, Cohen J, Schneider S, et al. Identification
Trials Group J Clin Oncol. 1998; 16:2651-2658.
of distinct fatigue trajectories in patients with breast cancer
27. Ami N Shaha, William J Gradishar. Adjuvant Anthracyclines undergoing adjuvant chemotherapy. Support Care Cancer.
in Breast Cancer What Is Their Role. Oncologist. 2018; 23: 2015; 23: 2579-2587.
1153-1161.

© 2022 Ngatali CFS, et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License

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