P-Glycoprotein Expression in Indian Breast Cancer Patients with Reference to Molecular Subtypes and Response to Anthracycline-Based Chemotherapy—a Prospective Clinical Study from a Developing Country
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Chemo-resistance is an important factor determining the response of tumor to neoadjuvant chemotherapy (NACT). Our study was aimed to determine the role of P-glycoprotein (P-glyp) expression as a predictor of response to NACT in locally advanced breast cancer (LABC) patients with special reference to molecular subtypes. Sixty cases of locally advanced breast cancer (LABC) were subjected to trucut biopsy and the tissue samples were evaluated immunohistochemically for P-glyp, ER, PR, and Her 2 neu status. Pre- and post-NACT P-glyp expression was correlated with clinical response (using WHO criteria after three cycles of CEF regimen) and molecular subtypes. The change in the P-glyp expression before (pre-) and after (post-) NACT was statistically significant with higher stage (p = 0.02), hormonal negative molecular subtypes (p = 0.01), and poor clinical response (p = 0.01). Pre-NACT-positive P-glyp expression is associated with higher stage and hormonal negative molecular subtypes and poor clinical response. The increased expression of P-glyp induced by NACT likely explains the concept of acquired chemo-resistance and may prove as an intermediate checkpoint in determining chemo-sensitivity for further treatment so that additional doses of ineffective chemotherapy may be avoided in non-responders translating into better patient safety.
KeywordsP-Glycoprotein Breast neoplasm Neoadjuvant chemotherapy Clinical response Molecular subtypes
MM contributed in the literature search, data acquisition, data analysis, and manuscript preparation and manuscript editing.
AA contributed in literature search, design, definition of intellectual content, data analysis, statistical analysis and manuscript preparation and editing.
KRS contributed in design, definition of intellectual content, data analysis, statistical analysis and manuscript preparation and editing.
SK contributed in literature search, data acquisition and manuscript preparation.
NH contributed in the data analysis, manuscript editing and review.
AAS contributed in the concept, design, and definition of intellectual content, manuscript editing and review.
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Conflicts of Interest
The authors declare that they have no conflict of interest.
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