Current and future role of neoadjuvant therapy for breast cancer

Abstract

a b s t r a c tNeoadjuvant systemic chemotherapy is a possible therapeutic approach for the treatment of locally advanced operable, primarily non-operable or inflammatory breast cancer. Neoadjuvant systemic chemotherapy is an option for breast cancer patients who would require adjuvant chemotherapy otherwise based on clinical and histological examination and imaging. The use of neoadjuvant systemic therapy in operable breast cancer is currently increasing because of its advantages that include higher rates of breast conserving surgery and the possibility of measuring early in-vivo response to systemic treatment. The timing of axillary sentinel lymph node diagnosis (i.e. before or after neoadjuvant chemotherapy) is critical in that it may influence the likelihood of axillary preservation. It is not yet clear if neoadjuvant therapy might improve outcomes in certain subgroups of breast cancer patients. Neoadjuvant treatment modalities require a close collaboration between oncology professionals, including surgeons, gynecologists, medical oncologists, radiation oncologists, radiologists and pathologists. The most important parameter for treatment success and improved overall survival is the achievement of a pathologic complete response (pCR), although the role of pCR in patients with luminal A like tumours might be less informative. Identification of patient subgroups with high pCR rates may allow less invasive surgical or radiological interventions. Patients not achieving a pCR may be candidates for postoperative clinical trials exploring novel systemic treatments.

Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study

“…This window was selected to exclude patients who might have received preopera tive systemic therapy for initially inoperable, locally advanced disease, since contemporary preoperative chemotherapy regimens are a minimum of 4-5 months in duration. 17 The plan for creating the cohort dataset is shown in Figure 1.…”

Breast Cancer: Influence of Taxanes on Response Assessment with Dynamic Contrast-enhanced MR Imaging

“…More recently, it has been proposed to use neoadjuvant induction chemotherapy to use pathologic response (presence or absence of pathologic complete response [PCR]) for further treatment stratification (3)(4)(5).…”

Axillary pathologic response after neoadjuvant chemotherapy in locally advanced breast cancer with axillary involvement

“…2,3 The main objectives of NCT are to reduce the tumor size (requiring a larger number of conservative surgical interventions), predict the prognosis of the disease according to tumor response to chemotherapy, reduce or eliminate distant micrometastases and monitor response to antineoplastic treatment in vivo. 4 For correct initial disease staging in breast cancer, physical examination is performed by breast and axillary palpation in addition to different complementary imaging methods (ultrasonography, mammography, MR and PET-CT). In cases in which the axilla is suspected of malignancy confirmation is recommended by fine needle aspiration puncture (FNAP) and/or lymph node biopsy.…”